Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(04): 1268-1274
DOI: 10.4103/ajns.AJNS_277_19
Case Report

Spontaneous closure of a cavernous sinus dural arteriovenous fistula with spinal perimedullary drainage (Cognard V) during attempted transvenous embolization

Prasert Iampreechakul
0   Department of Neurosurgery, Prasat Neurological Institute, Bangkok
,
Korrapakc Wangtanaphat
0   Department of Neurosurgery, Prasat Neurological Institute, Bangkok
,
Punjama Lertbutsayanukul
1   Department of Neuroradiology, Prasat Neurological Institute, Bangkok
,
Yodkhwan Wattanasen
1   Department of Neuroradiology, Prasat Neurological Institute, Bangkok
,
Somkiet Siriwimonmas
2   Department of Radiology, Bumrungrad International Hospital, Bangkok
› Author Affiliations
› Further Information
   Permissions and Reprints

The authors describe a patient with spontaneous closure of a spontaneous cavernous sinus dural arteriovenous fistula (CSDAVF), Cognard type V, during transvenous attempt. A 39-year-old woman experienced mild proptosis, redness of the left eye, and diplopia. Four months later, she developed left retro-orbital pain and left-sided headache. Cerebral angiography revealed the left CSDAVF exclusively draining into the superior petrosal sinus with subsequent drainage into the veins surrounding the medulla oblongata, and finally into the perimedullary spinal veins, classified as Cognard type V. The feeders arise from the dural branches of both the left external and internal carotid arteries. Following 2 h period of attempted transvenous embolization, the fistula disappeared spontaneously. Follow-up angiography obtained 6 months later confirmed complete resolution of the CSDAVF. At 2-year follow-up, the patient has remained clinically asymptomatic. The mechanism of thrombosis in this fistula related to the endovascular procedure. We speculated that putting the wire tip in the draining vein may induce the spontaneous thrombosis in the venous side. In addition, precipitating factors may include small, low-flow fistula, and pre-existing thrombosis.

Key-words:

Cavernous sinus - Cognard type V - dural arteriovenous fistula - spontaneous closure - thrombosis - transvenous embolization

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Lasjaunias P, Berenstein A, Ter Brugge KG. Surgical Neuroangiography. Vol. 2.2. New York: Springer-Verlag; 2004.
  • 2 Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 1986;64:724-30.
  • 3 Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: Classification, imaging findings, and treatment. AJNR Am J Neuroradiol 2012;33:1007-13.
  • 4 Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, et al. Cerebral dural arteriovenous fistulas: Clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995;194:671-80.
  • 5 Baltsavias G, Valavanis A. Endovascular treatment of 170 consecutive cranial dural arteriovenous fistulae: Results and complications. Neurosurg Rev 2014;37:63-71.
  • 6 Newton TH, Hoyt WF. Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology 1970;1:71-81.
  • 7 Seeger JF, Gabrielsen TO, Giannotta SL, Lotz PR. Carotid-cavernous sinus fistulas and venous thrombosis. AJNR Am J Neuroradiol 1980;1:141-8.
  • 8 Meyers PM, Halbach VV, Dowd CF, Lempert TE, Malek AM, Phatouros CC, et al. Dural carotid cavernous fistula: Definitive endovascular management and long-term follow-up. Am J Ophthalmol 2002;134:85-92.
  • 9 Viñuela F, Fox AJ, Debrun GM, Peerless SJ, Drake CG. Spontaneous carotid-cavernous fistulas: Clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 1984;60:976-84.
  • 10 Liu HM, Wang YH, Chen YF, Cheng JS, Yip PK, Tu YK. Long-term clinical outcome of spontaneous carotid cavernous sinus fistulae supplied by dural branches of the internal carotid artery. Neuroradiology 2001;43:1007-14.
  • 11 van Dijk JM, terBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke 2002;33:1233-6.
  • 12 Al-Afif S, Nakamura M, Götz F, Krauss JK. Spontaneous closure of a dural arteriovenous fistula. BMJ Case Rep 2014;7:1-6.
  • 13 Taniguchi RM, Goree JA, Odom GL. Spontaneous carotid-cavernous shunts presenting diagnostic problems. J Neurosurg 1971;35:384-91.
  • 14 Takahashi S, Tomura N, Watarai J, Mizoi K, Manabe H. Dural arteriovenous fistula of the cavernous sinus with venous congestion of the brain stem: Report of two cases. AJNR Am J Neuroradiol 1999;20:886-8.
  • 15 Shintani S, Tsuruoka S, Shiigai T. Carotid-cavernous fistula with brainstem congestion mimicking tumor on MRI. Neurology 2000;55:1929-31.
  • 16 Uchino A, Kato A, Kuroda Y, Shimokawa S, Kudo S. Pontine venous congestion caused by dural carotid-cavernous fistula: Report of two cases. Eur Radiol 1997;7:405-8.
  • 17 Kai Y, Hamada JI, Morioka M, Yano S, Ushio Y. Brain stem venous congestion due to dural arteriovenous fistulas of the cavernous sinus. Acta Neurochir (Wien) 2004;146:1107-11.
  • 18 Iampreechakul P, Tanpun A, Lertbusayanukul P, Siriwimonmas S. Contralateral extensive cerebral hemorrhagic venous infarction caused by retrograde venous reflux into the opposite basal vein of rosenthal in posttraumatic carotid-cavernous fistula: A case report and literature review. Interv Neuroradiol 2018;24:546-58.
  • 19 Shimada R, Kiyosue H, Tanoue S, Mori H, Abe T. Superior petrosal sinus: Hemodynamic features in normal and cavernous sinus dural arteriovenous fistulas. AJNR Am J Neuroradiol 2013;34:609-15.
  • 20 Miyamoto N, Naito I, Takatama S, Shimizu T, Iwai T, Shimaguchi H. Clinical and angiographic characteristics of cavernous sinus dural arteriovenous fistulas manifesting as venous infarction and/or intracranial hemorrhage. Neuroradiology 2009;51:53-60.
  • 21 Haryu S, Endo T, Sato K, Inoue T, Takahashi A, Tominaga T. Cognard type V intracranial dural arteriovenous shunt: Case reports and literature review with special consideration of the pattern of spinal venous drainage. Neurosurgery 2014;74:E135-42.
  • 22 Brunereau L, Gobin YP, Meder JF, Cognard C, Tubiana JM, Merland JJ. Intracranial dural arteriovenous fistulas with spinal venous drainage: Relation between clinical presentation and angiographic findings. AJNR Am J Neuroradiol 1996;17:1549-54.
  • 23 Iampreechakul P, Lertbusayanukul P, Wattanasen Y, Siriwimonmas S. Progressive medullary congestion resulting in life-threatening condition caused by lower cervical dural arteriovenous fistula successfully treated with endovascular treatment: A case report and literature review. Clin Med Rev Case Rep 2019;6:1-11.
  • 24 Iampreechakul P, Liengudom A, Wangtanaphat K, Lertbutsayanukul P, Wattanasen Y, Siriwimonmas S. Progressive cervical myelopathy caused by bilateral spontaneous high-flow vertebro-vertebral arteriovenous fistulas associated with fibromuscular dysplasia successfully treated by endovascular V2 segments sacrifice using fibered coils: A case report. Clin Med Rev Case Rep 2018;5:1-12.
  • 25 Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT, et al. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 1985;62:248-56.
  • 26 Kim DJ, terBrugge K, Krings T, Willinsky R, Wallace C. Spontaneous angiographic conversion of intracranial dural arteriovenous shunt: Long-term follow-up in nontreated patients. Stroke 2010;41:1489-94.
  • 27 Gemmete JJ, Chaudhary N, Pandey A, Ansari S. Treatment of carotid cavernous fistulas. Curr Treat Options Neurol 2010;12:43-53.
  • 28 Lucas CP, Zabramski JM, Spetzler RF, Jacobowitz R. Treatment for intracranial dural arteriovenous malformations: A meta-analysis from the English language literature. Neurosurgery 1997;40:1119-30.
  • 29 Halbach VV, Higashida RT, Hieshima GB, Hardin CW, Pribram H. Transvenous embolization of dural fistulas involving the cavernous sinus. AJNR Am J Neuroradiol 1989;10:377-83.
  • 30 Lekkhong E, Pongpech S, Ter Brugge K, Jiarakongmun P, Willinsky R, Geibprasert S. Transvenous embolization of intracranial dural arteriovenous shunts through occluded venous segments: Experience in 51 patients. AJNR Am J Neuroradiol 2011;32:1738-44.
  • 31 Lewis AI, Tomsick TA, Tew JM Jr. Management of 100 consecutive direct carotid-cavernous fistulas: Results of treatment with detachable balloons. Neurosurgery 1995;36:239-44.
  • 32 Berthelsen B, Svendsen P. Treatment of direct carotid-cavernous fistulas with detachable balloons. Acta Radiol 1987;28:683-91.
  • 33 Brosnahan D, McFadzean RM, Teasdale E. Neuro-ophthalmic features of carotid cavernous fistulas and their treatment by endoarterial balloon embolisation. J Neurol Neurosurg Psychiatry 1992;55:553-6.
  • 34 Uchino A, Takase Y, Koizumi T, Kudo S. Spontaneous thrombosis of a high-flow carotid-cavernous fistula after failed transarterial balloon occlusion. Interv Neuroradiol 2004;10:253-6.
  • 35 Whang K, Lee MS, Kim MS, Lee JY, Kwon W. Occlusion of traumatic carotid cavernous fistula by incidentally formed thrombus during the interventional procedure: A case report. Korean J Radiol 2006;7:215-7.
  • 36 Berenstein A, Lasjaunias P. Surgical Neuroangiography. Vol. 2. New York, NY: Springer-Verlag; 1987.
  • 37 Kendall B. Results of treatment of arteriovenous fistulae with the Debrun technique. AJNR Am J Neuroradiol 1983;4:405-8.
  • 38 Luciani A, Houdart E, Mounayer C, Saint Maurice JP, Merland JJ. Spontaneous closure of dural arteriovenous fistulas: Report of three cases and review of the literature. AJNR Am J Neuroradiol 2001;22:992-6.
  • 39 Warren DJ, Craven I, Romanowski CA, Coley SC. Spontaneous closure of a type 2a dural arteriovenous fistula following late recanalization of the occluded sinus. Interv Neuroradiol 2010;16:282-5.
  • 40 Voormolen V, Geens K, Van Den Hauwe L, Parizel PM. Spontaneous closure of cerebral dural arteriovenous fistulas with direct cortical venous drainage. A case report. Interv Neuroradiol 2009;15:359-62.
  • 41 Clarençon F, Biondi A, Sourour NA, Di Maria F, Iosif C, Nouet A, et al. Spontaneous closure of intracranial dural arteriovenous fistulas: A report of 3 cases. Clin Neurol Neurosurg 2013;115:971-5.
  • 42 Kai Y, Hamada J, Morioka M, Yano S, Kuratsu J. Treatment of cavernous sinus dural arteriovenous fistulae by external manual carotid compression. Neurosurgery 2007;60:253-7.
  • 43 Voigt K, Sauer M, Dichgans J. Spontaneous occlusion of a bilateral caroticocavernous fistula studied by serial angiography. Neuroradiology 1971;2:207-11.
  • 44 Ritchie WG, Lynch PR, Stewart GJ. The effect of contrast media on normal and inflamed canine veins. A scanning and transmission electron microscopic study. Invest Radiol 1974;9:444-55.
  • 45 Iampreechakul P, Tirakotai W, Tanpun A, Wattanasen Y, Lertbusayanukul P, Siriwimonmas S. Spontaneous resolution of direct carotid-cavernous fistulas: Case series and literature review. Interv Neuroradiol 2019;25:71-89.
  • 46 Hirata Y, Matsukado Y, Takeshima H, Seto H. Postpartum regression of a spontaneous carotid-cavernous fistula – Case report. Neurol Med Chir (Tokyo) 1988;28:673-6.
  • 47 El Asri AC, El Mostarchid B, Akhaddar A, Naama O, Gazzaz M, Boucetta M. Factors influencing the prognosis in intracranial dural arteriovenous fistulas with perimedullary drainage. World Neurosurg 2013;79:182-91.