A Case of Dural Arteriovenous Fistula in the Falx Cerebri: Case Report and Review of the Literature

Endovascular Management of Falcine Dural Arteriovenous Fistula-A Case Report and Review of Literature

Cranial dural arteriovenous (AV) fistulas are abnormal connections between the branches of dural arteries to dural veins or venous sinuses. They are most frequently located at the transverse sinus and cavernous sinus. They can occur at every cranial dural sinus. Dural AV fistula of falx cerebri is rare. A 62-year-old female presented with signs and symptoms of raised intracranial pressure. Radiological imaging revealed a dural AV fistula at the posterior one-third falx cerebri. She underwent transarterial embolization, and complete obliteration of the fistula was achieved. A detailed digital subtraction angiography study is warranted in patients with seemingly benign complaints like recurrent headaches, and falcine dural AV fistula should be identified and treated in the nick of time. We describe a very rare falcine dural AV fistula case and its management.

Purely Endoscopic Keyhole Approach for Resection of a Frontal Falx Dural Arteriovenous Fistula: A Technical Note

OBJECTIVE

Dural arteriovenous fistulas (DAVFs) in the falx cerebri are rare. This study presents a case of DAVF in the frontal falx cerebri that was successfully resected using a purely endoscopic keyhole microsurgical technique.

METHODS

A 69-year-old male patient presented to the emergency department with an acute onset seizure. His condition was diagnosed as a DAVF in the frontal falx cerebri with multiple fistula points. A purely endoscopic resection was performed under neuronavigation. Postoperative angiography and clinical follow-up were performed after 10 days and 3 months, respectively.

RESULTS

The DAVF was satisfactorily observed and resected using a purely endoscopic keyhole microsurgical technique, with no deterioration of neural functions or major vessel ruptures. Postoperative angiogram revealed complete obliteration of the DAVF and no recurrent epilepsy during the clinical follow-up.

CONCLUSIONS

Supported by sufficient preoperative evaluation and meticulous manipulation,a purely endoscopic minimally invasive resection is feasible and safe for DAVF, with the advantages of close observation and panoramic view.

A case of traumatic acute interhemispheric subdural hematoma due to injured dural branch of anterior cerebral artery

Background:

The precise causes of traumatic acute interhemispheric subdural hematoma (AISDH) are unclear in most cases, and there are few cases, where the sources of bleeding are directly confirmed intraoperatively. We report a rare case of traumatic AISDH, in which a damaged dural branch of anterior cerebral artery (ACA) to the cerebral falx was identified as the cause of bleeding during hematoma removal.

Case Description:

A 61-year-old man with a history of craniotomy for the left putaminal hemorrhage at the age of 50 fell from a bed, bruised his head, and lost consciousness. Computed tomography of the head showed AISDH of 2.5cm in thickness, which was removed through a parietal parasagittal craniotomy under the microscope. Intraoperatively, the bleeding source was revealed to be a damaged dural branch from ACA to the cerebral falx. There was no rebleeding during his stay in our hospital.

Conclusion:

In this case, intraoperative findings revealed that the cause of bleeding was a damage to the dural branch of ACA. A vascular study is mandatory to rule out a vascular malformation in similar cases.

A Case of Dural Arteriovenous Fistula in the Falx with Prominent Falcine Venous Plexus

Objective

The falx cerebri is known to have venous plexuses. Although some cases of dural arteriovenous fistula (DAVF) associated with falcine sinus have been reported, DAVF in the falx with prominent falcine venous plexus has not previously been reported.

Case Presentation

A 59-year-old male was hospitalized with head trauma. MRI incidentally showed a possible occipital DAVF. CTA and DSA revealed a DAVF in the flax with prominent falcine venous plexus. We performed a selective transarterial embolization with glue and particle, obtaining a complete occlusion of the fistula.

Conclusion

We report a rare case of DAVF in the flax with prominent falcine venous plexus that was successfully treated by a transarterial embolization.

A review of extraaxial developmental venous anomalies of the brain involving dural venous flow or sinuses: persistent embryonic sinuses, sinus pericranii, venous varices or aneurysmal malformations, and enlarged emissary veins

This paper is a narrative review of extraaxial developmental venous anomalies (eDVAs) of the brain involving dural venous flow or sinuses: persistent embryonic sinuses, sinus pericranii, enlarged emissary veins, and venous varices or aneurysmal malformations. The article highlights the natural history, anatomy, embryology, imaging, clinical implications, and neurosurgical significance of these lesions, which the authors believe represent a continuum, with different entities characterized by distinct embryopathologic features. The indications and surgical management options are discussed for these individual intracranial pathologies with relevant illustrations, and a novel classification is proposed for persistent falcine sinus (PFS). The role of neurointervention and/or microsurgery in specific cases such as sinus pericranii and enlarged emissary veins of the skull is highlighted. A better understanding of the pathophysiology and developmental anatomy of these lesions can reduce treatment morbidity and mortality. Some patients, including those with vein of Galen malformations (VOGMs), can present with the added systemic morbidity of a high-output cardiac failure. Although VOGM is the most studied and classified of the above-mentioned eDVAs, the authors believe that grouping the former with the other venous anomalies/abnormalities listed above would enable the clinician to convey the exact morphophysiological configuration of these lesions, predict their natural history with respect to evolving venous hypertension or stroke, and extrapolate invaluable insights from VOGM treatment to the treatment of other eDVAs. In recent years, many of these symptomatic venous malformations have been treated with endovascular interventions, although these techniques are still being refined. The authors highlight the broad concept of eDVAs and hope that this work will serve as a basis for future studies investigating the role of evolving focal venous hypertension/global intracranial hypertension and possibilities of fetal surgical intervention in these cases.