Spontaneous complete regression of malignant cavernous sinus dural arteriovenous fistula following partial transarterial embolization with liquid embolic material: Report of two cases

Iampreechakul, Prasert; Wangtanaphat, Korrapakc; Chuntaroj, Songpol; Wattanasen, Yodkhwan; Hangsapruek, Sunisa; Lertbutsayanukul, Punjama; Siriwimonmas, Somkiet

doi:10.25259/sni_594_2023

Surgical Neurology International

2023

DOI: 10.25259/sni_594_2023

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Spontaneous complete regression of malignant cavernous sinus dural arteriovenous fistula following partial transarterial embolization with liquid embolic material: Report of two cases

Prasert Iampreechakul,

Korrapakc Wangtanaphat,

Songpol Chuntaroj

et al.

Abstract: Background: Spontaneous complete regression of malignant cavernous sinus dural arteriovenous fistulas (CSDAVFs) following partial transarterial embolization is an extremely uncommon phenomenon. The mechanism responsible for this condition remains unclear. Case Description: The authors describe two cases of malignant CSDAVFs (Cognard IIb and V) treated by partial transarterial embolization with liquid embolic agents after unsuccessful transvenous embolization through various routes. Follow-up cerebral angio… Show more

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2024

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Cited by 3 publications

References 23 publications

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De novo formation of remote dural arteriovenous fistula following treated cavernous sinus dural arteriovenous fistula

Iampreechakul,

Wangtanaphat,

Chuntaroj

et al. 2024

World Neurosurgery: X

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De novo formation of remote dural arteriovenous fistula following treated cavernous sinus dural arteriovenous fistula

Iampreechakul,

Wangtanaphat,

Chuntaroj

et al. 2024

World Neurosurgery: X

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Holocord myelopathy misdiagnosed as neuromyelitis optica spectrum disorder (NMOSD): A unique case of dural arteriovenous fistula at the craniocervical junction along first spinal nerve

Iampreechakul,

Sopchokchai,

Wangtanaphat

et al. 2024

Surgical Neurology International

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Background: Dural arteriovenous fistulas (DAVFs) at the craniocervical junction (CCJ) involving the first spinal nerve represent a particularly rare and challenging subtype of DAVFs, with holocord myelopathy secondary to cerebrospinal DAVFs being an exceedingly rare presentation. Case Description: We report the case of a 70-year-old woman who presented with progressive paraparesis over 2 weeks. Initial magnetic resonance imaging (MRI) of the spine showed extensive holocord myelopathy, leading to a misdiagnosis of inflammatory myelopathy and subsequent inappropriate steroid treatment at a local hospital, which exacerbated her neurological symptoms. On transfer to our institution and further evaluation with MRI and magnetic resonance angiography, a lower thoracic DAVF was initially suspected. However, comprehensive spinal angiography failed to localize the fistula, prompting cranial angiography, which ultimately identified a DAVF at the CCJ along the C1 nerve root, supplied by a small radiculomeningeal branch of the left vertebral artery. Successful management involved coagulation of the proximal draining vein, with follow-up imaging confirming complete fistula obliteration and resolution of the holocord edema. Conclusion: This case highlights the diagnostic and therapeutic challenges associated with DAVFs at the CCJ, particularly when presenting with holocord myelopathy. It underscores the importance of a high index of suspicion and the need for timely, accurate diagnosis and intervention to prevent permanent spinal cord damage in such rare and complex cases.

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Spontaneous Resolution of an Aggressive Direct Carotid Cavernous Fistula Following Partial Transvenous Embolization Treatment: A Case Report and Review of Literatures

Liao,

Hsiao,

Chen

et al. 2024

Medicina

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Traumatic direct type carotid cavernous fistula (CCF) is an acquired arteriovenous shunt between the carotid artery and the cavernous sinus post severe craniofacial trauma or iatrogenic injury. We reported a 46-year-old woman who had developed a traumatic direct type CCF after severe head trauma with a skull base fracture and brain contusion hemorrhage. The clinical manifestations of the patient included pulsatile exophthalmos, proptosis, bruits, chemosis, and a decline in consciousness. Magnetic resonance imaging (MRI) revealed engorgement of the right superior ophthalmic vein (SOV), perifocal cerebral edema in the right frontal–temporal cortex, right basal ganglia, and brain stem. Digital subtraction angiography (DSA) disclosed a direct type high-flow CCF with an aggressive cortical venous reflux drainage pattern, which was attributed to Barrow type A and Thomas classification type 5. After partial treatment by transvenous coil embolization for the CCF, the residual high-flow fistula with aggressive venous drainage had an unusual rapid spontaneous resolution in a brief period. Therefore, it is strongly recommended to meticulously monitor the clinical conditions of patients and perform brain MRI and DSA at short intervals to determine the treatment strategy for residual CCF after partial endovascular treatment.

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Spontaneous complete regression of malignant cavernous sinus dural arteriovenous fistula following partial transarterial embolization with liquid embolic material: Report of two cases

Cited by 3 publications

References 23 publications

De novo formation of remote dural arteriovenous fistula following treated cavernous sinus dural arteriovenous fistula

De novo formation of remote dural arteriovenous fistula following treated cavernous sinus dural arteriovenous fistula

Holocord myelopathy misdiagnosed as neuromyelitis optica spectrum disorder (NMOSD): A unique case of dural arteriovenous fistula at the craniocervical junction along first spinal nerve

Spontaneous Resolution of an Aggressive Direct Carotid Cavernous Fistula Following Partial Transvenous Embolization Treatment: A Case Report and Review of Literatures

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