Fatal progression of posttraumatic dural arteriovenous fistulas refractory to multimodal therapy: Case report

J. A. Friedman, F. B. Meyer, D. A. Nichols, R. J. Coffey, L. N. Hopkins, C. O. Maher, I. D. Meissner, B. E. Pollock

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

The authors report the case of a man who suffered from progressive, disseminated posttraumatic dural arteriovenous fistulas (DAVFs) resulting in death, despite aggressive endovascular, surgical, and radiosurgical treatment. This 31-year-old man was struck on the head while playing basketball. Two weeks later a soft, pulsatile mass developed at his vertex, and the man began to experience pulsatile tinnitus and progressive headaches. Magnetic resonance imaging and subsequent angiography revealed multiple AVFs in the scalp, calvaria, and dura, with drainage into the superior sagittal sinus. The patient was treated initially with transarterial embolization in five stages, followed by vertex craniotomy and surgical resection of the AVFs. However, multiple additional DAVFs developed over the bilateral convexities, the falx, and the tentorium. Subsequent treatment entailed 15 stages of transarterial embolization; seven stages of transvenous embolization, including complete occlusion of the sagittal sinus and partial occlusion of the straight sinus; three stages of stereotactic radiosurgery; and a second craniotomy with aggressive disconnection of the DAVFs. Unfortunately, the fistulas continued to progress, resulting in diffuse venous hypertension, multiple intracerebral hemorrhages in both hemispheres, and, ultimately, death nearly 5 years after the initial trauma. Endovascular, surgical, and radiosurgical treatments are successful in curing most patients with DAVFs. The failure of multimodal therapy and the fulminant progression and disseminated nature of this patient's disease are unique.

Original languageEnglish (US)
Pages (from-to)831-835
Number of pages5
JournalJournal of neurosurgery
Volume94
Issue number5
DOIs
StatePublished - Jan 1 2001

Keywords

  • Dural arteriovenous fistula
  • Endovascular therapy
  • Intracerebral hemorrhage
  • Radiosurgery
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Friedman, J. A., Meyer, F. B., Nichols, D. A., Coffey, R. J., Hopkins, L. N., Maher, C. O., Meissner, I. D., & Pollock, B. E. (2001). Fatal progression of posttraumatic dural arteriovenous fistulas refractory to multimodal therapy: Case report. Journal of neurosurgery, 94(5), 831-835. https://doi.org/10.3171/jns.2001.94.5.0831