Superior petrosal sinus dural arteriovenous fistula resulting in subarachnoid hemorrhage after transvenous embolization: Case report

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  • 経静脈的塞栓術によってくも膜下出血を来した上錐体静脈洞部硬膜動静脈瘻の１例

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Objective: Dural arteriovenous fistulas (dAVFs) draining into the superior petrosal sinus (SPS) are rare. This article describes a case of SPS dAVF treated with transvenous embolization, which resulted in subarachnoid hemorrhage.<br>Case presentation: A 65-year-old female presented with a severe headache and floating sensations. CT showed right cerebellar hemorrhage with ventricular perforation. Angiograms revealed innumerable feeders from the tentorial artery of the left internal carotid artery, the left superior cerebellar artery supplying the dAVF at the draining vein and the varix of the SPS and cortical venous reflux via the petrosal vein. We conducted transvenous coil embolization of the draining vein and the varix, and the dAVF disappeared. CT obtained on the next day of the endovascular procedure demonstrated subarachnoid hemorrhage and acute hydrocephalus. It was postulated that because the embolization was performed at the varix and not at the shunt point, the fragile draining vein may have been ruptured due to excessive pressure or that rapid disproportion of venous pressure occurred at the surrounding draining veins during the procedure, causing subarachnoid hemorrhage.<br>Conclusion: We emphasize that accurate identification of the fistula sites and careful embolization with sufficient flow control are necessary in the treatment of dAVF with hemorrhages and dangerous drainages.

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