Spontaneous Closure of Transverse Sinus Dural Arteriovenous Fistula -Case Report-

Abstract

A 60-year-old man presented with transverse sinus dural arteriovenous fistula (AVF) manifesting as sudden onset of headache and nausea, which underwent spontaneous closure 5 years after the onset. Computed tomography on admission revealed small intraventricular hemorrhage in the right lateral ventricle. No intracranial vascular lesion was detected and magnetic resonance angiography was used at yearly follow up. Two years after the first admission, he suffered diplopia and cerebral angiography revealed transverse sinus dural AVF. Right pulsatile tinnitus occurred 4 years after the first admission. The symptoms suddenly disappeared 5 years after the first admission, and follow-up angiography showed disappearance of the dural AVF. The exact mechanism of the spontaneous occlusion of dural AVF remains unknown. This case of spontaneous transverse sinus dural AVF closure occurred without disruption of sinus patency, suggesting that thrombosis of the draining veins into sinuses was not involved.

Spontaneous Angiographic Conversion of Intracranial Dural Arteriovenous Shunt

“…15 However, not all spontaneous occlusions have been associated with angiographically visible sinus thrombosis. 16,27 Luciani et al hypothesized that spontaneous closures may occur by changes in the structure of the sinus wall. They proposed that intrinsic compression of the shunts within the sinus wall caused by focal increase in the sinus size may be a key mechanism.…”

“…16 Saito et al suggested that changes in flow dynamics such as reduction of shunt flow from the external carotid artery in addition to the venous changes may be an important factor. 27 Despite the angiographic absence of thrombosis, histological study of DAVS lesions suggests that A 51-year-old man presented with swallowing difficulty and slurred speech, which began 3 years ago. He also had pulsatile bruit.…”

Intracranial Dural Arteriovenous Fistulas: Classification, Imaging Findings, and Treatment

“…19 Cases of spontaneous thrombosis/resolution of DAVFs have also been reported. [21][22][23][24][25][26][27] Any change in a patient's symptoms can reflect exacerbations of the venous drainage pattern and prompt further imaging work-up.…”

Spontaneous closure of a dural arteriovenous fistula

“…In addition to the above mentioned cases, Saito and colleagues presented a patient in whom closure of a longstanding dAVF (36 months) was observed within a month after cardiac catheter angiography. 1 Intracranial hemorrhage was suggested as another cause initiating spontaneous closure of a dAVF. 10 Such dAVFs were usually more complex Cognard type II or III.…”

“…Only a few cases of spontaneous closure of a dural arteriovenous fistula (dAVF) have been reported. [1][2][3][4][5][6][7][8][9][10][11] Various precipitating factors have been postulated which include venous thrombosis, post-angiographic changes, and intracranial hemorrhage. [2][3][4][5][6] Although Figure 1 (A) Initial transfemoral cerebral angiography of the right external carotid artery before the intracerebral bleeding, lateral view, demonstrating early shunts to the sigmoid sinus via feeders from the left occipital artery, left ascending pharyngeal artery, and left middle meningeal artery.…”