Multiple dural arteriovenous fistulas developing at different locations: A report of two cases and a review of the literature

Abstract

Objective : We experienced and reported two rare cases with multiple dural arteriovenous fistulas (DAVFs). Case reports: Case 1: A 73-year-old woman presented with diplopia. Angiography revealed multiple DAVFs involving both the left cavernous and the left transverse-sigmoid sinuses. The cavernous sinus lesion was associated with retrograde leptomeningeal venous drainage (RLVD) into the pons, which was successfully obliterated with transvenous embolization. Case 2: A 75-year-old woman presented with diplopia. Multiple DAVFs were found both in a region that was like a parallel sinus adjacent to the sinus confluence and the left cavernous sinus, which were successfully treated with transarterial embolization. Conclusion: Multiple DAVFs are rare, accounting for 7 to 8% of all intracranial and spinal DAVFs. Many of those lesions were reported to have RLVD with a high risk of bleeding. Selecting the proper treatment is important based on a precise diagnosis on the hemodynamic condition of the brain and the fistulas.