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      Pontine venous congestion due to dural arteriovenous fistula of the cavernous sinus: Case report and review of the literature

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          Abstract

          Background:

          We report herein a case of cavernous sinus (CS)-dural arteriovenous fistula (DAVF) with brainstem venous congestion that was successfully treated by transarterial embolization, followed by radiotherapy.

          Case Description:

          An 80-year-old woman presented with right eye chemosis and left hemiparesis. T2-weighted magnetic resonance imaging showed hyperintensity of the pons. Diagnostic cerebral angiography demonstrated CS-DAVF draining into the right superior orbital vein and petrosal vein, and fed by bilateral internal and external carotid arteries. Transarterial embolization was performed and followed by radiotherapy, resulting in resolution of the pontine lesion and neurological and ophthalmological symptoms within 5 months.

          Conclusions:

          We also review the literature regarding therapy for CS-DAVF with brainstem venous congestion. Once CS-DAVF with venous congestion of the brainstem has been definitively diagnosed, immediate therapy is warranted. Treatment with transarterial embolization followed by radiation may be an important option for elderly patients when transvenous or transarterial embolization is not an option.

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          New concept in cavernous sinus dural arteriovenous fistula: correlation with presenting symptom and venous drainage patterns.

          T. J. Kim, S. Kwon, Michael Kook … (2005)
          An extradurally located cavernous sinus dural arteriovenous fistula (CSDAVF) exhibits different clinical behavior from other dural arteriovenous fistulas (DAVFs) located between 2 dural leaves. The aim of this study is to define angiographic types of CSDAVF associated with presenting symptom (Sx) and venous drainage patterns. CSDAVFs during a mean of 23-month follow-up period of 58 patients (17 to 73 years, male:female ratio=8:50) were retrospectively analyzed. The 3 types of CSDAF, ie, proliferative (PT), restrictive (RT), and late restrictive (LRT) types, were categorized by the degrees and patterns of prominent arteriovenous shunt as well as venous flow. The status of the venous connection with CS and the presenting Sx patterns classified as orbital (OrbSxP), ocular (OcuSxP), cavernous (CavSxP), and cerebral (CerSxP) were associated with angiographic types as well as symptom onset, age, and gender. Correlations of discrete and categorical variables were statistically analyzed using the chi2 or Fisher exact test. PT (n=23) and RT (n=23) of CSDAVF were more common than LRT (n=12) (P=0.016) in patients with younger than 65 years and were related to OrbSxP (P=0.015) and CavSxP (P=0.038) in contrast to LRT to OcuSxP (P=0.004). Early onset of Sxs was related to the OrbSxP (P=0.08) and CavSxP (P<0.001). CerSxP (5%) was noted in RT or LRT. OrbSxP was related to the superior ophthalmic venous drainage (P=0.026) and CavSxP to the inferior petrosal sinus (P=0.046) and posterior fossa venous drainages (P=0.014). Seven patients revealed chronological progression of CSDAVF from PT to LRT and even to complete healing. CSDAVF presents as 3 distinctive angiographic types and is associated with presenting Sxs and venous drainage patterns.
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            Diagnosis and management of dural carotid-cavernous sinus fistulas.

            Michael R. Miller (2006)
            A carotid-cavernous sinus fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. Some fistulas are characterized by a direct connection between the cavernous segment of the internal carotid artery (ICA) and the cavernous sinus, whereas others consist of a communication between the cavernous sinus and one or more meningeal branches of the ICA, external carotid artery, or both. These dural fistulas usually have low rates of arterial blood flow and until recently were difficult to diagnose and treat. In this paper, the author discusses the anatomy, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of dural CCFs.
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              Brain stem venous congestion due to dural arteriovenous fistulas of the cavernous sinus.

              J-I Hamada, M Morioka, Y Ushio … (2004)
              Venous congestion of the brain stem due to dural arteriovenous fistulas (DAVFs) in the cavernous sinus is rare and presents therapeutic challenges. To assess the prognosis of patients with symptomatic DAVFs and brain stem dysfunction, we evaluated the degree of venous ischemia by examining pre- and post-treatment magnetic resonance images (MRI) in 2 patients presenting with venous congestion of the brain stem. A 56-year-old woman with left hemiparesis and a 70-year-old woman with gait disturbance attributable to right cavernous sinus DAVFs were referred to our hospital. In both cases, T2-weighted magnetic resonance imaging (MRI) disclosed a hyperintensity lesion in the brainstem due to venous congestion. Both patients underwent open surgery for direct embolization of the cavernous sinus because there were no approach routes for transvenous embolization. The patient whose pretreatment MRI demonstrated Gd enhancement continued to manifest neurological deficits and persistence of the abnormal hyperintensity on post-treatment T2-weighted MRI. In the other patient whose pretreatment MRI showed no Gd enhancement, treatment produced a complete response of her neurological deficit and disappearance of the abnormal hyperintensity area. We tentatively conclude that lesions corresponding to hyperintensity areas on non-Gd-enhanced, T2-weighted MRI may reflect a reversible condition whereas lesions identified as hyperintense areas on GD-enhanced T2-weighted MRI may be indicative of irreversibility.
              Article 0 comments Cited 11 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Surg Neurol Int
                Journal ID (iso-abbrev): Surg Neurol Int
                Journal ID (publisher-id): SNI
                Title: Surgical Neurology International
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2229-5097
                ISSN (Electronic): 2152-7806
                Publication date Collection: 2012
                Publication date (Electronic): 14 May 2012
                Volume: 3
                Electronic Location Identifier: 53
                Affiliations
                [1 ]Department of Neurosurgery, National Center for Global Health and Medicine, Gunma, Japan
                [2 ]Department of Radiology, National Center for Global Health and Medicine, Gunma, Japan
                [3 ]Department of Neurosurgery, Gunma University, Gunma, Japan
                Author notes
                [* ]Corresponding author
                Article
                Publisher ID: SNI-3-53
                DOI: 10.4103/2152-7806.96076
                PMC ID: 3356981
                PubMed ID: 22629490
                SO-VID: f25ea5d8-ffe9-4778-882c-23ab2a0e7d64
                Copyright © Copyright: © 2012 Miyagishima T.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 25 March 2012
                Date accepted : 09 April 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: pontine venous congestion,radiation therapy,transarterial embolization,cavernous dural arteriovenous fistula
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: pontine venous congestion, radiation therapy, transarterial embolization, cavernous dural arteriovenous fistula

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