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

Abstract

A 67-year-old man presented with consciousness disturbance and right hemiparesis. Computed tomography (CT) scan showed an intracerebral hematoma with two enhanced vascular lesions. Digital subtraction angiography revealed the dural arteriovenous fistula (dAVF) in the falx cerebri which was supplied by both bilateral middle meningeal arteries and left pericallosal artery and drained into both the superior sagittal sinus and the vein of Galen via the posterior callosal vein accompanied by two venous pouches. The dAVF was obliterated by a combination of the endovascular and the direct surgeries. A dAVF in a falx cerebri is very rare and only five cases were reported. Clinical characteristics of the dAVFs are uncertain. Before deciding the strategy of treatment, it is important to consider the pathological condition including embryology of the falx, the falcine sinus, and the falcine venous plexus.

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

“…[2,6] e falcine sinus connecting the superior and inferior sagittal sinuses may be left behind during fetal life, and the dAVF in which the falcine sinus becomes a drainer is a falcine sinus dAVF. [10,11] In the present case, because a branch of ACA appeared to have flowed into the cerebral falx, it is the possibility that a dAVF such as a falcine sinus dAVF preexisted the AISDH: the craniotomy to remove the left putaminal hemorrhage might have caused changes in venous and intracranial pressure and have contributed to the development of the dAVF. In addition to underlying vascular malformation like a dAVF, other possible causes for the AISDH in our case are as follows: (1) A bridging vein might rupture during the fall to form AISDH, and the expansion of the AISDH could have stretched the ACA branch between the brain and the falx, resulting in its rupture, although no bridging vein injuries were found intraoperatively; and (2) the ACA branch could have iatrogenically ruptured during removal of the hematoma in the interhemispheric fissure, although hematoma removal was performed under the microscope to identify the source of bleeding and to avoid vascular injuries in this case.…”

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

“…The DAVF in the falx cerebri is considered rare and only seven cases have been reported to our best knowledge. [3][4][5][6][7][8][9] Most of their cases seem to associate with the falcine sinus. Our case revealed a shunted venous pouch connecting small venous channels in the falx.…”

“…As for the drainers of the DAVFs in the falx cerebri, Yamaguchi et al 3) speculated that part of the drainers were the vein was evident. Under local anesthesia, a 7.2Fr introducer sheath was inserted into the right femoral artery.…”

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

“…For surgical treatment of a dural arteriovenous fistula (DAVF), resection of the falx cerebri, including the falcine sinus as well as the abnormal falcine plexus, is an appropriate strategy, according to Yamaguchi et al 74 Surgi- cal treatment of atretic cephalocele may be considered if there is reasonable risk for traumatic injury, seizures, and/ or bleeding as well as for cosmetic reasons. In many endoscopic cases, such as interhemispheric approaches, inadvertent parafalcine subdural hematomas are found, likely due to falcine plexus injury.…”