Two cases of dural arteriovenous fistula that developed after surgery in sites remote from the craniotomy

Abstract

We report two cases of dural arteriovenous fistula (dAVF) that developed after surgery at sites that were remote from the craniotomy location. Case 1 A 41-year-old obese woman underwent clipping for a ruptured anterior communicating artery aneurysm, using an interhemispheric approach. Twenty days after the surgery, she developed dAVFs in the bilateral convexity, which were fed by the middle meningeal arteries, and drained into the middle meningeal veins. The dAVFs disappeared spontaneously after 1 year of observation. Case 2- A 69-year-old woman underwent clipping for an unruptured left internal carotid-posterior communicating artery aneurysm, using left pterional approach under exposure of the cervical internal carotid artery. Preoperative cerebral angiography demonstrated the presence of a left sigmoid sinus stenosis. Eight months after the surgery, she experienced pulsatile tinnitus, and a dAVF in the left transverse-sigmoid sinus was confirmed by cerebral angiography. A near complete obliteration of the dAVF was achieved by transarterial and transvenous embolization. We speculate that venous hypertension, due to obesity in case 1 and due to pre-existing sigmoid sinus stenosis and manipulation of the cervical internal carotid artery in case 2, caused the development of the dAVFs.