BACKGROUND Developmental venous anomalies (DVAs) are congenital anatomical variants of the normal deep parenchymal veins. DVAs are occasionally found incidentally on brain imaging, and most cases are asymptomatic. However, they rarely cause central nervous disorders. Herein, a case of mesencephalic DVA that caused aqueduct stenosis and hydrocephalus and discuss its diagnosis and treatment is reported. OBSERVATIONS The patient was a 48-year-old female who presented with depression. Computed tomography and magnetic resonance imaging (MRI) of the head revealed obstructive hydrocephalus. Contrast-enhanced MRI revealed an abnormally distended linear region with enhancement on the top of the cerebral aqueduct, which was confirmed as a DVA by digital subtraction angiography. An endoscopic third ventriculostomy (ETV) was performed to improve the patient’s symptoms. Intraoperative endoscopic imaging showed obstruction of the cerebral aqueduct by the DVA. LESSONS This report describes a rare case of obstructive hydrocephalus caused by DVA. It highlights the usefulness of contrast-enhanced MRI for diagnosing cerebral aqueduct obstructions due to DVAs and the effectiveness of ETV as a treatment option.
We report a case of subarachnoid hemorrhage in a 66-year-old man. A 3-mm aneurysm of the long circumflex branch of the P1 segment of the posterior cerebral artery was revealed by computed tomography angiography, and this was recognized as the bleeding source based on the hematoma distribution. In addition, the aneurysm was diagnosed as a flow-related aneurysm because the long circumflex branch was the main feeder of the tentorial dural arteriovenous fistula (dAVF). It was considered ideal to prevent re-rupture of the aneurysm and to treat the tentorial dAVF with simultaneous drainage occlusion by endovascular treatment. However, considering the shape of the aneurysm, preservation of the parent artery seemed to be difficult with endovascular treatment; therefore, only the ruptured aneurysm was treated by clipping first and then the tentorial dAVF was treated with endovascular treatment. The patient had a good clinical course without any complications. This case may be helpful in determining the ideal treatment in similar cases.
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