J Korean Neurosurg Soc.  2015 Mar;57(3):204-207. 10.3340/jkns.2015.57.3.204.

A Case of Dural Arteriovenous Fistula of Superior Sagittal Sinus after Tamoxifen Treatment for Breast Cancer

Affiliations
  • 1Department of Neurosurgery, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea. nshsg@ewha.ac.kr

Abstract

We are reporting an unusual case of dural arteriovenous fistula (AVF) of the superior sagittal sinus (SSS) after tamoxifen treatment for breast cancer. A 30-year-old female arrived at the emergency room with a sudden headache and left sided weakness and sensory loss. In her past medical history, she was diagnosed with breast cancer 1 year prior, and subsequently underwent a breast conserving mastectomy with whole breast radiation and adjuvant chemotherapy with tamoxifen. At the time of admission, computed tomography showed a small acute intracerebral hemorrhage at the right parietal cortex, and magnetic resonance imaging showed that a dural AVF at the SSS with a prominent and tortuous venous enhancement along the centrum semiovale was present. Cerebral angiography showed that the dural AVF at the mid-portion of the SSS with meningeal arterial feeding vessels entering the wall of the SSS, then draining through the dilated cortical veins. Our patient had no signs of active malignancy or any abnormalities in her coagulation profile, so it can be concluded that the tamoxifen was the likely cause of the SSS thrombosis and dural AVF. The dural AVF was treated by an endovascular coil embolization for the arterialized segment of the SSS. The patient dramatically recovered favorably from left side motor and sensory deficit. The best clinical approach is to screen potential patients of tamoxifen hormonal therapy and educate them on the sign and symptoms of life threatening thromboembolic events while taking tamoxifen.

Keyword

Dural fistula; Superior sagittal sinus; Tamoxifen; Breast cancer

MeSH Terms

Adult
Breast
Breast Neoplasms*
Central Nervous System Vascular Malformations*
Cerebral Angiography
Cerebral Hemorrhage
Chemotherapy, Adjuvant
Embolization, Therapeutic
Emergency Service, Hospital
Female
Headache
Humans
Magnetic Resonance Imaging
Mastectomy
Rabeprazole
Superior Sagittal Sinus*
Tamoxifen*
Thrombosis
Veins
Tamoxifen

Figure

  • Fig. 1 A : Computed tomography axial image demonstrate a small intracerebral hemorrhage in the right parietal cortex. B and C : Magnetic resonance imaging demonstrate thrombosis at the posterior segment of superior sagittal sinus and dural arteriovenous fistula with a prominent and tortuous venous enhancement along the centrum semiovale.

  • Fig. 2 External carotid artery angiography demonstrate dural arteriovenous fistula at the mid-portion of a superior sagittal sinus. The meningeal arterial feeders enter the wall of the superior sagittal sinus, and, then drain through the dilated cortical veins (corkscrew vessels). The dilated cortical veins with venous hypertension, may be related to acute right intracerebral hemorrhage at the right parietal cortex.

  • Fig. 3 The dural arteriovenous fistula was treated by an endovascular coil embolization for a superior sagittal sinus through navigation of the meningeal artery.

  • Fig. 4 A and B : Post-embolization angiography shows the disappearance of the dural arteriovenous fistula at the mid-portion of the superior sagittal sinus. C : Postoperative MRI shows an interval improvement of the dilated cortical veins.


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