Delayed dural arteriovenous fistula after microvascular decompression for hemifacial spasm

Development of a sigmoid sinus dural arteriovenous fistula secondary to sigmoid sinus thrombosis after resection of a foramen magnum meningioma: illustrative case

BACKGROUND

The precise etiology of dural arteriovenous fistula (DAVF) is still unknown. The authors reported a case of delayed postoperative sigmoid sinus (SS) DAVF secondary to SS thrombosis after resection of a foramen magnum meningioma through a suboccipital craniotomy.

OBSERVATIONS

The authors visualized the clear architecture of the DAVF using fusion three-dimensional computer graphics (3DCG) images reconstructed from multimodal imaging studies. These fusion 3DCG images revealed that the feeders of the DAVF had connected through neovascularization to the SS at the previous thrombus site. The authors also reviewed previously reported cases of DAVFs that developed after craniotomy.

LESSONS

This study indicated that SS stenosis and occlusion with sinus thrombosis are possible risk factors for delayed postoperative DAVF that demand special consideration.

Acquired dural arteriovenous fistula after cerebellopontine angle meningioma: A case report

RATIONALE

Intracranial brain surgeries, including ventriculostomy, burr hole, craniotomy, and craniectomy, are the most common causes of acquired dural arteriovenous fistula (dAVF). Here we report a case of acquired dAVF after a cerebellopontine angle meningioma surgery.

PATIENT CONCERNS

A 51-year-old woman was diagnosed with a 40-mm cerebellopontine angle meningioma. The patient underwent surgery via a retrosigmoid suboccipital approach. A small craniotomy and an additional craniectomy were performed. At 7 months after the surgery, she presented with pulsating tinnitus and headache.

DIAGNOSIS

Magnetic resonance imaging and digital subtraction angiography showed a dAVF that was fed by the occipital artery and drained into transverse and sigmoid sinuses.

INTERVENTIONS

We performed Onyx® (Irvine, CA) embolization.

OUTCOMES

The patient's symptoms completely improved.

LESSONS

Craniectomy defects, partially exposed sinuses, and incomplete cranioplasty might be risk factors for iatrogenic dAVF after a retrosigmoid suboccipital craniotomy or craniectomy. Complete reconstructive cranioplasty is an essential procedure to prevent a direct connection between the venous sinus and the external carotid artery.

Delayed Onset of Dural Arteriovenous Fistula Following Trauma

Dural Arteriovenous Fistulas (dAVF) are pathological shunts that are often idiopathic in presentation. However, it is reported that many patients presenting with dAVF have past medical histories notable for surgeries, hypercoagulation disorders, infections, and trauma. In trauma-linked dAVF, presentation generally occurs within 48 h post-incident. In the present case, the authors discuss the delayed onset of a Borden type II dAVF in a patient 12 hospital days post-trauma, as well as the course of treatment. This unique case provides a compelling demonstration for providers to be aware of the development of dAVF, even after the typical 48-hour post-trauma window. By being aware of the possibility of delayed dAVF presentation, delayed diagnosis or misdiagnosis can be avoided and emergent action can be taken.

Delayed Dural Arteriovenous Fistula at the Transverse-Sigmoid Sinus Secondary to Petroclival Meningioma Surgery Via Far Lateral Approach

Intracranial dural arteriovenous fistulas (DAVFs) are typified by pathological anastomoses between meningeal arteries and dural venous sinuses or cortical veins. There are many causes contributing to the etiology of DAVFs. Among the variable causes, acquired DAVFs secondary to craniotomy had rarely been reported, especially for delayed DAVFs at the transverse-sigmoid sinus. Till now, there are only 12 published cases of delayed DAVFs at the transverse-sigmoid sinus secondary to craniotomy. Herein, the authors describe such an extraordinary rare case secondary to petroclival meningioma resection via far lateral approach, and to the best knowledge of us, this is the first well-documented case of delayed DAVF at the transverse-sigmoid sinus following far lateral craniotomy. Furthermore, cases of delayed DAVFs at the transverse-sigmoid sinus secondary to craniotomy were reviewed and investigated, and the clinical characteristics and treatment were also broadly discussed.

Microvascular Decompression Surgery for Hemifacial Spasm

OBJECTIVE

This study aims to investigate the operative efficacy, surgical complication rate, and surgical strategy of microvascular decompression (MVD) for hemifacial spasm (HFS).

METHODS

Clinical data of 46 patients with HFS who underwent MVD were retrospectively analyzed.

RESULTS

During surgery, it was found that the facial nerve root exit zone was compressed by the following arterial vessels: anterior inferior cerebellar artery in 24 patients (52.17%); posterior inferior cerebellar artery in 14 patients (30.43%); vertebral artery and a small artery in 7 patients (15.22%); and vertebral artery in 1 patient (2.18%). Symptoms of 38 patients were immediately remitted completely after surgery and symptoms of 8 patients were significantly reduced. Main complications included dizziness and tinnitus in 9 patients, hearing loss in 5 patients, cerebrospinal fluid leakage in 1 patient, and infection in 2 patients. No patient died during surgery.

CONCLUSIONS

MVD is the preferred choice for treating idiopathic hemifacial spasm, and hearing impairment is the main complication. Skilled microsurgical techniques, as well as identifying and completely decompressing offending vessels, are the key to ensuring a successful microvascular decompression.

Delayed postoperative dural arteriovenous fistula presenting with progressive dementia

A 64-year-old woman underwent right suboccipital craniotomy to treat spontaneous cerebrospinal fluid (CSF) otorrhoea. Although the CSF leak was cured, the patient developed pulsatile tinnitus, ambulatory disturbance and progressive dementia. Four years after the surgery, she presented with generalised seizure. Cerebral angiography showed a dural arteriovenous fistula at the right transverse-sigmoid sinus, which was associated with sinus occlusion, retrograde blood flow in the sinus and diffuse intracranial cortical venous reflux. A combination of endovascular transarterial embolisation and transvenous embolisation with direct sinus puncture was performed. After the procedure, the patient's mental status and cognitive function improved significantly.