J Cerebrovasc Endovasc Neurosurg.  2021 Sep;23(3):260-265. 10.7461/jcen.2021.E2021.01.002.

Superior sagittal sinus dural arteriovenous fistula caused by treatment of meningioma masquerades as sinus thrombosis

• Gigliotti MJ
• Patel N
• Simon S

• KMID: 2520886
• DOI: http://doi.org/10.7461/jcen.2021.E2021.01.002

Abstract

Dural arteriovenous fistulas (DAVF) are rare acquired lesions resulting from abnormal shunting between intracranial dural arteries and venous system. Typically arising from structural weakness of the dura and a coinciding trigger factor, DAVFs can present with similar clinical and imaging characteristics to sinus thrombosis. A 61-year-old male with a history of meningioma previously managed with subtotal resection and stereotactic radiosurgery presented with progressive right-sided vision loss and bilateral papilledema. Initial imaging suggested possible sinus occlusion. Catheter angiogram revealed a Borden-Shucart grade III DAVF of the superior sagittal sinus and elevated venous pressures and the patient subsequently underwent endovascular transarterial intervention twice. We report on the first case of a superior sagittal sinus DAVF occurring after surgical resection of a parasagittal meningioma.

Keyword

Superior sagittal sinus; Dural arteriovenous fistula; Meningioma; Endovascular therapy

Figure

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  Fig. 1. Magnetic resonance imaging (MRI). (A), (B) Axial and coronal view of parafalcine meningioma with tumor extension into the superior sagittal sinus. (C) MRI venogram revealing anterior-to-mid superior sagittal sinus occlusion as a result of tumor invasion of the sinus.

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  Fig. 2. Digital subtraction angiography (DSA), lateral view. Superior sagittal sinus dural arteriovenous fistula with the bilateral superficial temporal, bilateral meningeal, and right occipital arterial feeding vessels and retrograde cortical venous drainage (Borden-Shucart grade III; Cognard grade III).

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  Fig. 3. Digital subtraction angiography (DSA), lateral view. First embolization leading to complete obliteration of the left meningeal feeding artery and right anterior branch of the middle meningeal artery as well as slowing of flow (A). Follow-up embolization 2 weeks later was performed on the right posterior branch of the middle meningeal and right occipital artery revealing residual dural arteriovenous fistula with continued right-sided feeding from the left via the occipital artery (B).

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  Fig. 4. Digital subtraction angiography (DSA), lateral view in (A) arterial phase from external carotid artery injection, (B) arterial phase from internal carotid artery injection, and (C) venous phase following internal carotid artery injection. Follow-up angiography 3 months after initial embolization demonstrates complete obliteration of the dural arteriovenous fistula.

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