Intracranial dural arteriovenous fistula with perimedullary venous drainage: Anatomical, clinical and therapeutic considerations about one case, and review of the literature

Intracranial dural arteriovenous fistulae with perimedullary venous drainage are unusual type of vascular brain malformations. Patients may present with a rapidly progressive ascending myelopathy associated with autonomic dysfunction, which can cause a misdiagnosis and delay the therapeutic manageme...

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Bibliographic Details
Published in:Neuro-chirurgie 2013-06, Vol.59 (3), p.133
Main Authors: Mathon, B, Gallas, S, Tuillier, T, Bekaert, O, Decq, P, Brugieres, P, Nouet, A, Gaston, A
Format: Article
Language:fre
Subjects:
Brain - diagnostic imaging
Brain - pathology
Carotid Artery, Internal - pathology
Carotid Artery, Internal - surgery
Central Nervous System Vascular Malformations - diagnosis
Central Nervous System Vascular Malformations - pathology
Central Nervous System Vascular Malformations - therapy
Cerebral Angiography
Diagnosis, Differential
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Neurologic Examination
Neurosurgical Procedures
Prognosis
Spinal Cord - pathology
Treatment Outcome
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Summary:Intracranial dural arteriovenous fistulae with perimedullary venous drainage are unusual type of vascular brain malformations. Patients may present with a rapidly progressive ascending myelopathy associated with autonomic dysfunction, which can cause a misdiagnosis and delay the therapeutic management. These clinical signs must be quickly recognized to avoid a poor outcome. The authors report the case of a 60-year-old woman presenting with a progressive myelopathy due to a dural arteriovenous fistula with perimedullary venous drainage. The diagnosis was suspected on brain-spinal MRI and confirmed by brain arteriography visualizing the arteriovenous shunt in the middle segment of the superior petrous sinus. MRI showed edema in the medulla oblongata. The treatment was performed early by endovascular glue embolization of the arteriovenous shunt and of the origin of the vein. Brain arteriography and clinical follow-up, one month later, showed complete disappearance of the dural fistula and regression of clinical symptoms. MRI control showed the reduction of the brain stem edema. Because of the early pejorative prognosis of these kinds of fistulae, early diagnosis and treatment are needed.
ISSN:1773-0619
DOI:10.1016/j.neuchi.2013.04.009