A Case of Posterior Fossa Dural Arteriovenous Fistulas Successfully Treated with Transarterial Embolization

Abstract

A 40-year-old man was transferred to our hospital due to sudden headache while swimming in the pool. CT revealed cerebellar haematoma within vermis associated with subarachnoid haemorrhage (SAH). Digital subtraction angiography (DSA) showed dural arteriovenous fistulas (DAVFs) with venous pouch on the surface of cerebellar vermis. Fistulas were on the meningeal surface near the sinus confluence. Draining veins formed venous pouch invaginating into cerebellar vermis. Transarterial embolization (TAE) was performed under the concept that main feeder should be embolized last to occlude the DAVFs completely. Post-embolization 3D-CT showed the cast of N-butyl –cyanoacrylate (NBCA) in the fistulas as well as in the drainer. The good order of occlusion made the embolization complete. We reported a case of DAVFs that has successfully treated with TAE. The key components of success in TAE are to know the precise anatomy of individual lesion and dangerous anastomoses. Also the awareness of the possible alteration in appearance of the DAVFs during treatment is essential. In practice it is crucial to make a decision of the order of embolization before procedure. More specifically we have to decide in advance which feeder should be embolized last. 3D-CT is a good tool for the post treatment assessment of NBCA distribution in the DAVFs.