Bilateral ethmoidal dural arteriovenous fistulae: a previously unreported entity: case report.

Abstract:

OBJECTIVE AND IMPORTANCE:Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. Reported hemorrhage rates have ranged from 62 to 91%, and an aggressive clinical course is more likely than a benign clinical course. We describe the first case of a patient with bilateral ethmoidal dural AVFs. CLINICAL PRESENTATION:A 50-year-old man presented with posterior fossa subarachnoid hemorrhage and cerebellar intraparenchymal hemorrhage. Angiography revealed a tentorial AVF and a complex anterior ethmoidal dural AVF. INTERVENTION:The tentorial AVF was treated with preoperative embolization and surgical obliteration. On follow-up angiography, the ethmoidal dural AVF was not considered amenable to embolization. A right modified orbitozygomatic approach was performed and the right-sided fistula was interrupted. Intraoperative angiography revealed obliteration of the right-sided fistula, but a persistent fistula on the left. Further surgical exploration revealed this contralateral anterior ethmoidal dural AVF, which was clip ligated. No residual fistula was noted on intraoperative angiography. CONCLUSION:Anterior ethmoidal dural AVFs may occur bilaterally. Given their complex angiographic appearance, their presence bilaterally may not be readily apparent on preoperative angiography. Intraoperative angiography is crucial to identify a contralateral fistula and to verify that ligation has been curative.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Deshmukh VR,Chang S,Albuquerque FC,McDougall CG,Spetzler RF

doi

10.1093/neurosurgery/57.4.e809

subject

Has Abstract

pub_date

2005-10-01 00:00:00

pages

E809

issue

4

eissn

0148-396X

issn

1524-4040

journal_volume

57

pub_type

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