Spontaneous closure of an aggressive non-traumatic dural arteriovenous fistula

Abstract

Background: We describe a case of a non-traumatic dural arteriovenous fistula (dAVF) with cortical venous reflux (CVR) that closed spontaneously with simultaneous intracerebral hemorrhage. We reviewed the literature to discuss about the mechanism of spontaneous closure and an optimal timing of treatment for aggressive dAVF with benign presentation. Case description: A 71-year-old woman presented with right ocular conjunctival hyperemia and diplopia without history of trauma. The initial digital subtraction angiography (DSA) demonstrated a right cavernous sinus dAVF, Borden type III, with a single feeder of anterior branch of the right middle meningeal artery, shunting at the posterior part of the right cavernous sinus wall, and draining into the right superficial middle cerebral vein, not into the right superior ophthalmic vein. Because of CVR, endovascular therapy was planned. Two months later, she was admitted to our hospital presenting generalized convulsion. CT scan showed a multilobulated hematoma in the right frontal lobe. The control DSA revealed disappearance of the dAVF. She had a cognitive dysfunction as a sequele of hemorrhage. Conclusions: In the literature, spontaneous closures of non-traumatic dAVF with CVR were reported in 21 cases. It may cause neurological sequele as the present case experienced. The mechanism of spontaneous closure is unknown and may include factors to be elucidated. We recommend prompt diagnosis and treatment for patients with dAVF with CVR even if associated with benign onset.

Keywords

• Cavernous sinus
• Cerebral haemorrhage
• Treatment timing