Intracranial dural AV fistula- An unfolding enigma
Journal Title: Indian Journal of Neurosciences - Year 2018, Vol 4, Issue 3
Abstract
An Intracranial dural arteriovenous fistulas DAVF is an abnormal direct connection fistula between a meningeal artery and a meningeal vein or dural venous sinus cortical vein 1 When there are multiple fistulas they are termed as dural arteriovenous malformations and comprise 1015 of all intracranial arteriovenous malformations1Here we present a case of52yr old patient who presented to our casualty with history of sudden onset of headache giddiness and vomiting followed by loss of consciousness Neurological examination revealed impairment of consciousness no verbal response with left hemiparesis E2V1M5 Bilaterally pupils were 5mm and sluggishly reacting to light Vitals were stable with BP recording of 14080 mm of hg and a pulse rate of 80 min Pre contrast CT scan showed an intraparenchymal haemorrhage with perilesional oedema in the right frontal regionCT angiography brainshoweda intracranial dural AVF with varix and adjacent intraparenchymal haemorrhageDSA revealed a Borden type III Cognard type IV midline dural Arteriovenous fistula in the regionofmid superior sagittal sinus and along the cerebral falx with a large venous ectasiavarix along the anterior cerebral falxManagement Patient underwent afronto parietal rectangular craniotomy Right posterior frontal parasagittal engorged bunch of focal cortical veins was cauterized Underlying haematoma was evacuated and the underlying venous ectasia varix identified It was found to be thrombosed A large draining vein was found which was clipped and any consequent brain swelling was looked for before finally excising it in totoPost op period was uneventful with the patient gradually improving in sensorium with residual hemiplegia and aphasiaAlthough recent developments in catheter interventionhas made it the preferred option in most of the cases surgery is still preferred in some select casesKeywordsIntracranial dural AV fistula Superior sagittal sinus Cognard and borden classification CT andiography Digital subtraction angiography
Authors and Affiliations
Rajesh Shenoy, Ravi Ichalakaranji, Prakash Mahantshetti
Keywords
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