Treatment Strategy of a Patient With a Brain Arteriovenous Malformation and Cranial Dural Fistula: 2-Dimensional Operative Video

Mithun G. Sattur, Karl R. Abi-Aad, Fucheng Tian, Matthew E. Welz, Barrett Anderies, Bernard Bendok

Research output: Contribution to journalArticle

Abstract

We present the case of a 56-yr-old right-handed male, after informed consent was obtained, who presented with acute confusion and agitation, on the background of a remote history of an uncomplicated resection of a left parietal grade 2 glioma. Imaging revealed a large, acute right temporal intracerebral hemorrhage (ICH). Standard vascular workup for the cause of the ICH included catheter angiography. No direct cause of the hemorrhage was revealed; however, a high grade parasagittal dural arteriovenous fistula (DAVF) with cortical venous reflux was noted close to the prior craniotomy site. The venous reflux was towards the left hemisphere, but it was hypothesized that similar reflux on the right side may have been present and was not presently evident due to thrombosis. The DAVF was embolized by endovascular means, followed by evacuation of the hematoma. Follow-up angiogram 7 mo later revealed a high-flow, right superior temporal cortical arteriovenous malformation (AVM). The DAVF unfortunately had also progressed. Endovascular occlusion of both lesions was attempted but was not successful. Subsequently, microsurgical resection for both the vascular malformations was performed with careful pre- and intraoperative planning to obtain a successful clinical and angiographic result. In this video, we summarize diagnostic and therapeutic nuances that have broad implications for the workup of ICH and the strategic management of a unique scenario involving a brain AVM and high-grade cranial dural fistula in the same patient. Prior to each procedure, informed consent was obtained from the patient, which includes consent for publication.

Original languageEnglish (US)
Number of pages1
JournalOperative neurosurgery (Hagerstown, Md.)
Volume16
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Central Nervous System Vascular Malformations
Arteriovenous Malformations
Cerebral Hemorrhage
Fistula
Informed Consent
Angiography
Brain
Vascular Malformations
Craniotomy
Glioma
Hematoma
Blood Vessels
Publications
Thrombosis
Therapeutics
Catheters
Hemorrhage

Keywords

  • Angiogram
  • Arteriovenous malformation
  • AVM
  • AVM surgery
  • DAVF
  • DAVF surgery
  • Dural arteriovenous fistula
  • Endovascular embolization
  • ICH
  • Intracerebral hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Treatment Strategy of a Patient With a Brain Arteriovenous Malformation and Cranial Dural Fistula : 2-Dimensional Operative Video. / Sattur, Mithun G.; Abi-Aad, Karl R.; Tian, Fucheng; Welz, Matthew E.; Anderies, Barrett; Bendok, Bernard.

In: Operative neurosurgery (Hagerstown, Md.), Vol. 16, No. 5, 01.05.2019.

Research output: Contribution to journalArticle

Sattur, Mithun G. ; Abi-Aad, Karl R. ; Tian, Fucheng ; Welz, Matthew E. ; Anderies, Barrett ; Bendok, Bernard. / Treatment Strategy of a Patient With a Brain Arteriovenous Malformation and Cranial Dural Fistula : 2-Dimensional Operative Video. In: Operative neurosurgery (Hagerstown, Md.). 2019 ; Vol. 16, No. 5.
@article{90e31c52434a4f10854963d97ce896a4,
title = "Treatment Strategy of a Patient With a Brain Arteriovenous Malformation and Cranial Dural Fistula: 2-Dimensional Operative Video",
abstract = "We present the case of a 56-yr-old right-handed male, after informed consent was obtained, who presented with acute confusion and agitation, on the background of a remote history of an uncomplicated resection of a left parietal grade 2 glioma. Imaging revealed a large, acute right temporal intracerebral hemorrhage (ICH). Standard vascular workup for the cause of the ICH included catheter angiography. No direct cause of the hemorrhage was revealed; however, a high grade parasagittal dural arteriovenous fistula (DAVF) with cortical venous reflux was noted close to the prior craniotomy site. The venous reflux was towards the left hemisphere, but it was hypothesized that similar reflux on the right side may have been present and was not presently evident due to thrombosis. The DAVF was embolized by endovascular means, followed by evacuation of the hematoma. Follow-up angiogram 7 mo later revealed a high-flow, right superior temporal cortical arteriovenous malformation (AVM). The DAVF unfortunately had also progressed. Endovascular occlusion of both lesions was attempted but was not successful. Subsequently, microsurgical resection for both the vascular malformations was performed with careful pre- and intraoperative planning to obtain a successful clinical and angiographic result. In this video, we summarize diagnostic and therapeutic nuances that have broad implications for the workup of ICH and the strategic management of a unique scenario involving a brain AVM and high-grade cranial dural fistula in the same patient. Prior to each procedure, informed consent was obtained from the patient, which includes consent for publication.",
keywords = "Angiogram, Arteriovenous malformation, AVM, AVM surgery, DAVF, DAVF surgery, Dural arteriovenous fistula, Endovascular embolization, ICH, Intracerebral hemorrhage",
author = "Sattur, {Mithun G.} and Abi-Aad, {Karl R.} and Fucheng Tian and Welz, {Matthew E.} and Barrett Anderies and Bernard Bendok",
year = "2019",
month = "5",
day = "1",
doi = "10.1093/ons/opy208",
language = "English (US)",
volume = "16",
journal = "Operative Neurosurgery",
issn = "2332-4252",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Treatment Strategy of a Patient With a Brain Arteriovenous Malformation and Cranial Dural Fistula

T2 - 2-Dimensional Operative Video

AU - Sattur, Mithun G.

AU - Abi-Aad, Karl R.

AU - Tian, Fucheng

AU - Welz, Matthew E.

AU - Anderies, Barrett

AU - Bendok, Bernard

PY - 2019/5/1

Y1 - 2019/5/1

N2 - We present the case of a 56-yr-old right-handed male, after informed consent was obtained, who presented with acute confusion and agitation, on the background of a remote history of an uncomplicated resection of a left parietal grade 2 glioma. Imaging revealed a large, acute right temporal intracerebral hemorrhage (ICH). Standard vascular workup for the cause of the ICH included catheter angiography. No direct cause of the hemorrhage was revealed; however, a high grade parasagittal dural arteriovenous fistula (DAVF) with cortical venous reflux was noted close to the prior craniotomy site. The venous reflux was towards the left hemisphere, but it was hypothesized that similar reflux on the right side may have been present and was not presently evident due to thrombosis. The DAVF was embolized by endovascular means, followed by evacuation of the hematoma. Follow-up angiogram 7 mo later revealed a high-flow, right superior temporal cortical arteriovenous malformation (AVM). The DAVF unfortunately had also progressed. Endovascular occlusion of both lesions was attempted but was not successful. Subsequently, microsurgical resection for both the vascular malformations was performed with careful pre- and intraoperative planning to obtain a successful clinical and angiographic result. In this video, we summarize diagnostic and therapeutic nuances that have broad implications for the workup of ICH and the strategic management of a unique scenario involving a brain AVM and high-grade cranial dural fistula in the same patient. Prior to each procedure, informed consent was obtained from the patient, which includes consent for publication.

AB - We present the case of a 56-yr-old right-handed male, after informed consent was obtained, who presented with acute confusion and agitation, on the background of a remote history of an uncomplicated resection of a left parietal grade 2 glioma. Imaging revealed a large, acute right temporal intracerebral hemorrhage (ICH). Standard vascular workup for the cause of the ICH included catheter angiography. No direct cause of the hemorrhage was revealed; however, a high grade parasagittal dural arteriovenous fistula (DAVF) with cortical venous reflux was noted close to the prior craniotomy site. The venous reflux was towards the left hemisphere, but it was hypothesized that similar reflux on the right side may have been present and was not presently evident due to thrombosis. The DAVF was embolized by endovascular means, followed by evacuation of the hematoma. Follow-up angiogram 7 mo later revealed a high-flow, right superior temporal cortical arteriovenous malformation (AVM). The DAVF unfortunately had also progressed. Endovascular occlusion of both lesions was attempted but was not successful. Subsequently, microsurgical resection for both the vascular malformations was performed with careful pre- and intraoperative planning to obtain a successful clinical and angiographic result. In this video, we summarize diagnostic and therapeutic nuances that have broad implications for the workup of ICH and the strategic management of a unique scenario involving a brain AVM and high-grade cranial dural fistula in the same patient. Prior to each procedure, informed consent was obtained from the patient, which includes consent for publication.

KW - Angiogram

KW - Arteriovenous malformation

KW - AVM

KW - AVM surgery

KW - DAVF

KW - DAVF surgery

KW - Dural arteriovenous fistula

KW - Endovascular embolization

KW - ICH

KW - Intracerebral hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=85064853256&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064853256&partnerID=8YFLogxK

U2 - 10.1093/ons/opy208

DO - 10.1093/ons/opy208

M3 - Article

C2 - 30202995

AN - SCOPUS:85064853256

VL - 16

JO - Operative Neurosurgery

JF - Operative Neurosurgery

SN - 2332-4252

IS - 5

ER -