Iatrogenic dural arteriovenous fistula and aneurysmal subarachnoid hemorrhage

Abstract

<jats:p>The authors present the case of a patient who presented acutely with aneurysmal subarachnoid hemorrhage (SAH) and a contralateral iatrogenic dural arteriovenous fistula (DAVF). Diagnostic angiography was performed, revealing a right-sided middle cerebral artery (MCA) aneurysm and a left-sided DAVF immediately adjacent to the entry of the ventriculostomy and bur hole site. A craniotomy was performed for clipping of the ruptured MCA aneurysm, and the patient subsequently underwent endovascular obliteration of the DAVF 3 days later. The authors present their treatment of an iatrogenic DAVF in a patient with an aneurysmal SAH, considerations in management options, and a literature review on the development of iatrogenic DAVFs.</jats:p>

Iatrogenic dural arteriovenous fistula after radical neck dissection for metastatic malignant disease: A case report

“…Intracranial surgery is the most common etiology of iatrogenic dAVF. Through a literature search, we found 16 cases of dAVF developing after ventriculostomy, burr hole, craniotomy, or craniectomy and thromboarteriotomy of ICA stenosis . Seven cases seemed to be directly related to the site of surgery (Table ) …”

“…Various mechanisms have been suggested to be associated with dAVF formation, including indigenous dural arteriovenous shunts opened and enlarged under the influence of a change in intracranial pressure after surgery, trauma to dural vessels or the ICA, after apposition of the scalp or muscle blood vessels to the dura, and postoperative thrombus formation in the sinus as well as venous sinus thrombosis …”

“…The arteriovenous shunt is located within the leaflets of the dura mater, and is supplied by the carotid or vertebral arteries, or commonly their branches found adjacent to dural venous sinuses. On the basis of etiology, dAVF may be broadly categorized as congenital or acquired . The formation of acquired dAVF may be associated with sinus occlusion, trauma, or iatrogenic injury after craniotomy, and has also been reported after thromboarteriotomy of internal carotid stenosis…”

“…The presentation depends on the rate of flow through the fistula and venous drainage. This may lead to venous congestion, pial/cortical venous reflux associated with venous hypertension, and/or hemorrhage …”

Iatrogenic dural arteriovenous fistula after surgical resection of a ruptured brain arteriovenous malformation

“…[1] Intracranial hemorrhage is the most common presentation of brain arteriovenous malformations (AVMs), and microsurgical resection is one of the mainstays of therapy for these uncommon and challenging cerebrovascular lesions. [2] However, an iatrogenic DAVF after AVM resection has not been previously described.…”