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Abstract and Introduction
Abstract
The authors present the case of a patient who presented acutely with aneurysmal subarachnoid hemorrhage (SAH) and a contralateral iatrogenic dural arteriovenous fistula (DAVF). Diagnostic angiography was performed, revealing a right-sided middle cerebral artery (MCA) aneurysm and a left-sided DAVF immediately adjacent to the entry of the ventriculostomy and bur hole site. A craniotomy was performed for clipping of the ruptured MCA aneurysm, and the patient subsequently underwent endovascular obliteration of the DAVF 3 days later. The authors present their treatment of an iatrogenic DAVF in a patient with an aneurysmal SAH, considerations in management options, and a literature review on the development of iatrogenic DAVFs.
Introduction
Dural arteriovenous fistulas present uncommonly, representing only 10%–15% of all intracranial AVMs. As an arteriovenous shunt contained within the leaflets of the dura mater and supplied by dural branches of the carotid or vertebral arteries that can be found adjacent to dural venous sinuses, a DAVF may occur as a congenital or acquired entity. The formation of an acquired DAVF is associated with sinus occlusion, trauma, or iatrogenic injury after craniotomies. Its behavior largely depends on venous drainage; thus concern for accompanying pial venous reflux leading to venous hypertension or hemorrhage is imperative, particularly in the setting of vasospasm. We present a DAVF induced after twist-drill craniotomy for placement of a bedside ventriculostomy in a patient with an aneursymal SAH. We discuss factors involved in the formation of the DAVF, review considerations involving whether to treat and by which means, and review the literature on iatrogenic DAVFs.
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