Direct surgical approach of a congenital dural arteriovenous fistula at the torcular herophili in a neonate

Abstract

Congenital dural arteriovenous fistulas (AVFs) in neonates are extremely unusual lesions, and those located at the torcular herophili are even rarer. 1‐3,5 This case illustrates the treatment potential and the case for direct surgical repair in a neonate with a dural AVF at the torcular herophili. The girl was delivered via a cesarean section at 36 weeks’ gestation and weighed 2800 g. Apgar scores were 8 at 1 minute and 10 at 5 minutes. The infant’s head circumference was 39 cm with diastatic sutures and a full bregmatic fontanel. Except for occipitocervical bruits, the neurological examination was normal. Echocardiography disclosed a small ventricular septal defect. Neuroimaging was performed (Figs. 1 and 2). At 50 days of age, the girl underwent a midline suboccipital approach. Posterior fossa durotomy, evacuation of the clot, and coagulation of the pouch were performed. The arachnoid space of the posterior fossa was not open. One month postsurgery, a ventriculoperitoneal (VP) shunt was inserted for persistent hydrocephalus. At 3-year follow up (Fig. 3), the girl had made a complete recovery, exhibiting no developmental delay and no neurological deficits. With the progress of interventional angiography, dural AVFs are usually treated by transarterial embolization instead of ligation of the feeding vessel or resection. 4 After therapeutic angiography, the mortality rate in patients with congenital dural AVFs has been reported to be 31 to 38%, whereas that in neonates has been reported to be 67%. 3,4