Bilateral ethmoidal dural arteriovenous fistulae: a previously unreported entity: case report.

Abstract

OBJECTIVE AND IMPORTANCE:

Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. Reported hemorrhage rates have ranged from 62 to 91%, and an aggressive clinical course is more likely than a benign clinical course. We describe the first case of a patient with bilateral ethmoidal dural AVFs.

CLINICAL PRESENTATION:

A 50-year-old man presented with posterior fossa subarachnoid hemorrhage and cerebellar intraparenchymal hemorrhage. Angiography revealed a tentorial AVF and a complex anterior ethmoidal dural AVF.

INTERVENTION:

The tentorial AVF was treated with preoperative embolization and surgical obliteration. On follow-up angiography, the ethmoidal dural AVF was not considered amenable to embolization. A right modified orbitozygomatic approach was performed and the right-sided fistula was interrupted. Intraoperative angiography revealed obliteration of the right-sided fistula, but a persistent fistula on the left. Further surgical exploration revealed this contralateral anterior ethmoidal dural AVF, which was clip ligated. No residual fistula was noted on intraoperative angiography.

CONCLUSION:

Anterior ethmoidal dural AVFs may occur bilaterally. Given their complex angiographic appearance, their presence bilaterally may not be readily apparent on preoperative angiography. Intraoperative angiography is crucial to identify a contralateral fistula and to verify that ligation has been curative.

• Authors: Vivek R Deshmukh, Steve Chang, Felipe C Albuquerque, Cameron G McDougall, Robert F Spetzler
• Journal: Neurosurgery (Neurosurgery) Vol. 57 Issue 4 Pg. E809 (Oct 2005) ISSN: 1524-4040 [Electronic] United States
• PMID: 17152660 (Publication Type: Case Reports, Journal Article)

Topics

• Carotid Artery, Internal (diagnostic imaging, surgery)
• Cerebral Angiography
• Cranial Fossa, Anterior (blood supply, surgery)
• Dura Mater (blood supply, surgery)
• Embolization, Therapeutic
• Ethmoid Bone (blood supply, surgery)
• Humans
• Intracranial Arteriovenous Malformations (complications, surgery, therapy)
• Intraoperative Care
• Ligation
• Male
• Middle Aged
• Ophthalmic Artery (abnormalities, surgery)
• Subarachnoid Hemorrhage (etiology, therapy)