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      The impact of different imaging modalities in diagnosis and management of patient with dural arteriovenous fistula: A rare case report

      case-report

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          Abstract

          In vascular neurosurgery, dural arteriovenous fistulas (DAVFs) are a difficult, challenging condition whose natural history and therapy are still debated. This case report presented a 30-year-old male patient who experienced intermittent headaches for two months, along with gradual weakness in all four limbs, resulting in quadriplegia. Magnetic resonance imaging (MRI), computed tomography (CT), and digital subtraction angiography (DSA) played a significant role in the diagnosis of the patient, in which the final diagnosis was vascular myelopathy due to Dural arteriovenous fistula (DAVF). A successful embolization procedure of arteriovenous fistula using balloon-assisted liquid embolic agents, through branches of the right occipital artery was performed, resulting in complete obliteration of the fistula. In order to improve the neurovascular symptoms that had previously been reported, the patient was effectively undergoing rehabilitation, with notable progress.

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          Most cited references19

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          Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.

          To review the symptoms and progression of dural arteriovenous fistulas (AVFs) and correlate the findings with various angiographic patterns. Patterns of venous drainage allowed classification of dural AVFs into five types: type I, located in the main sinus, with antegrade flow; type II, in the main sinus, with reflux into the sinus (IIa), cortical veins (IIb), or both (IIa + b); type III, with direct cortical venous drainage without venous ectasia; type IV, with direct cortical venous drainage with venous ectasia; and type V, with spinal venous drainage. Type I dural AVFs had a benign course. In type II, reflux into the sinus induced intracranial hypertension in 20% of cases, and reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was present in 40% of cases of type III dural AVFs and 65% of type IV. Type V produced progressive myelopathy in 50% of cases. This classification provides useful data for determination of the risk with each dural AVF and enables decision-making about the appropriate therapy.
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            Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment.

            Intracranial DAVFs are pathologic dural-based shunts and account for 10%-15% of all intracranial arteriovenous malformations. These malformations derive their arterial supply primarily from meningeal vessels, and the venous drainage is either via dural venous sinuses or through the cortical veins. DAVFs have a reported association with dural sinus thrombosis, venous hypertension, previous craniotomy, and trauma, though many lesions are idiopathic. The diagnosis is dependent on a high level of clinical suspicion and high-resolution imaging. Cross-sectional imaging techniques by using CT and MR imaging aid in the diagnosis, but conventional angiography remains the most accurate method for complete characterization and classification of DAVFs. The pattern of venous drainage observed on dynamic vascular imaging determines the type of DAVF and correlates with the severity of symptoms and the risk of hemorrhage.
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              A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment.

              A classification is proposed that unifies and organizes spinal and cranial dural arteriovenous fistulous malformations (AVFMs) into three types based upon their anatomical similarities. Type I dural AVFMs drain directly into dural venous sinuses or meningeal veins. Type II malformations drain into dural sinuses or meningeal veins but also have retrograde drainage into subarachnoid veins. Type III malformations drain into subarachnoid veins and do not have dural sinus or meningeal venous drainage. The arterial supply in each of these three types is derived from meningeal arteries. The anatomical basis of the proposed classification is presented with several cases that illustrate the three types of dural AVFMs. A rationale for the treatment of spinal and cranial dural AVFMs according to their anatomical characteristics is discussed.
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                Author and article information

                Contributors
                Journal
                Trauma Case Rep
                Trauma Case Rep
                Trauma Case Reports
                Elsevier
                2352-6440
                07 June 2024
                August 2024
                07 June 2024
                : 52
                : 101044
                Affiliations
                [a ]Department of Diagnostic Radiology, College of Applied Medical Sciences, University of Ha'il, Hail, Saudi Arabia
                [b ]Medical Imaging Department, King Abdullah bin Abdul-Aziz University Hospital, Riyadh, Saudi Arabia
                [c ]Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.0 Box 84428, Riyadh 11671, Saudi Arabia
                [d ]Medical Imaging Department, King Fahad Medical City, Riyadh, Saudi Arabia
                [e ]Almaarfa University, Riyadh, Saudi Arabia
                [f ]Department of Radiotherapy, College of Medical Radiologic Sciences, Sudan University of Science and Technology, P.O. Box 11111, Khartoum, Sudan
                Author notes
                [* ]Corresponding author at: Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.0. 84428, Riyadh 11671, Saudi Arabia. zyhamd@ 123456pnu.edu.sa
                Article
                S2352-6440(24)00067-0 101044
                10.1016/j.tcr.2024.101044
                11214945
                38952476
                7f7a881c-8417-4adc-9549-5ebcd66b8597
                © 2024 The Authors. Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 4 June 2024
                Categories
                Case Report

                intracranial,dural arteriovenous fistula,mra,cta
                intracranial, dural arteriovenous fistula, mra, cta

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