Endovascular treatment of vein of Galen dural arteriovenous fistula presenting as dementia

Abstract

Dural arteriovenous fistula (DAVF) is an important cause of neurological dysfunction that is often misdiagnosed, especially in elderly population. Galenic DAVFs are a subtype of the rare falcotentorial DAVFs with a high risk of hemorrhage and aggressive clinical course. In most cases, DAVFs present with pulsatile tinnitus, headache, or orbital symptoms such as chemosis and proptosis. We report a patient with DAVF of Vein of Galen presented with progressive dementia, treated by Onyx embolisation and had good clinical outcome.

Imaging Characteristics of Dural Arteriovenous Fistulas Involving the Vein of Galen: A Comprehensive Review

“…Imaging is a critical aspect in the diagnosis of a VGAM. A VGAM requires a sensitive imaging input for an early detection, which would allow for a careful obstetric monitoring in order to prevent a fatal ICH [ 1 , 5 , 11 - 12 , 14 ]. A prenatal diagnosis of a VGAM offers an opportunity to plan the delivery at a center equipped with a multidisciplinary team who can provide the ideal care [ 11 ].…”

“…Dural arteriovenous fistula (DAVF) is a rare condition that arises from acquired arteriovenous shunts within the dura mater [ 1 - 3 ]. This cerebral arteriovenous malformation involves a single or multiple arterial vessel(s) that feed into a developing choroid, an accumulation of dysplastic vessels, and histologically appears as a congregation of veins, which are arterialized due to the high-pressure arterial system feeding into them.…”

“…This cerebral arteriovenous malformation involves a single or multiple arterial vessel(s) that feed into a developing choroid, an accumulation of dysplastic vessels, and histologically appears as a congregation of veins, which are arterialized due to the high-pressure arterial system feeding into them. Classically, the choroid can either be fed via a single or by multiple vessel(s) [ 1 , 4 ]. DAVFs represent 10% to 15% of all cerebrovascular malformations.…”

“…DAVFs represent 10% to 15% of all cerebrovascular malformations. A rare subtype of a DAVF is the vein of Galen aneurysmal malformation (VGAM), which is also known as the median prosencephalic arteriovenous fistula (Figure 1 ) [ 1 , 5 ]. This uncommon subtype of DAVF presents in a more serious and dramatic manner in infancy [ 1 , 6 ].…”

Galenic dural arteriovenous fistula in neurofibromatosis type 1 treated with Onyx

“…7,8 Depending on the anatomy, a trans-arterial, transvenous, combined transarterial/transvenous approach can be used to cure a DAVF. 9 Multiple embolisation agents can be used. However, liquid embolisation agents and coils are primarily used.…”