Brain Circulation (Jan 2023)

Dural arteriovenous fistula of the torcular herophili presenting with hydrocephalus and venous congestion in an 8-month-old child: A case report

  • Dimitri T K. Ndandja,
  • Gerald Musa,
  • Rossi E C. Barrientos,
  • Matvey I Livshitz,
  • Suzy N J. Manko,
  • Gennady E Chmutin,
  • Hovrin V Dmitri,
  • Bupe M Mwela,
  • Slabov V Mihail

DOI
https://doi.org/10.4103/bc.bc_71_22
Journal volume & issue
Vol. 9, no. 1
pp. 39 – 43

Abstract

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Dural arteriovenous fistulas (DAVFs) are direct communication between the dural arterial and venous systems. They are more common in adults. In children, they are relatively rare. Hydrocephalus is a common problem in pediatrics with a variety of causes. However, very few cases of hydrocephalus as a complication of DAVF have been reported in the literature. This case describes an 8-month-old male child with a large DAVF at the torcular herophili who presented with regression of milestones and hydrocephalus. Magnetic resonance imaging (MRI) on admission showed triventricular hydrocephalus and a massively dilated torcular with a compressed fourth ventricle. Angiography confirmed the presence of a DAVF at the torcula with arterial feeders from the posterior circulation. Endovascular embolization was performed with >80% embolization of the fistula with no complications. Control MRI immediately postoperative was acceptable. No cerebrospinal fluid (CSF) diversion was performed. At a 3-month follow-up, the child had attained all developmental milestones for age. MRI showed normal CSF dynamics and a further reduction in the size of the torcula. Despite being rare, DAVFs should be considered as a possible cause of pediatric hydrocephalus, and treating them can lead to a resolution of the mechanisms inducing hydrocephalus. CSF shunting should be reserved for those cases with persistent hydrocephalus and raised intracranial pressure despite endovascular treatment.

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