Abstract
Intracranial dural arteriovenous fistulae (DAVF) are rare vascular malformations. They are generally considered to be acquired lesions, often attributed to dural sinus thrombosis and intracranial venous hypertension. The authors encountered a case of DAVF associated with an octreotide-positive vestibular schwannoma. A 46-year-old female had symptoms of right ear congestion accompanied by pulsatile tinnitus and mild hearing loss. Magnetic resonance imaging (MRI) identified a lobulated mass centered at the cerebellopontine angle. Preoperatively, on cerebral angiography, there was an incidental discovery of a DAVF in the right posterior fossa. The decision was made to proceed with resection of the tumor in a staged fashion. Her latest follow-up MRI showed no evidence of recurrent tumor. This is the second reported case of DAVF associated with an intracranial schwannoma. Findings are discussed along with a thorough review of the literature. This case, combined with the data from the literature review, led us to believe that tumor-related angiogenesis might contribute to DAVF formation.
Highlights
Intracranial dural arteriovenous fistulae (DAVF) are abnormal direct shunts between dural arteries and dural venous sinuses, meningeal veins or cortical veins
The authors encountered a case of DAVF associated with an octreotide-positive vestibular schwannoma
DAVF primarily occur in adult patients and are most commonly located in the transverse-sigmoid sinus region followed by the cavernous sinus; any intracranial venous sinus may be involved [2]
Summary
Intracranial dural arteriovenous fistulae (DAVF) are abnormal direct shunts between dural arteries and dural venous sinuses, meningeal veins or cortical veins. Following embolization using Onyx in the right AICA and SCA DAVF (dural arteriovenous fistula) feeders, left vertebral artery DSA (digital subtraction angiogram) injection (C) demonstrates significant reduction in arteriovenous shunting. She had a long recovery from the surgery due to the lower cranial nerve palsies but has shown gradual improvement Her latest follow-up MRI (48 months from surgery) (Figure 1D) showed no evidence of recurrent tumor; there was some residual posterior fossa DAVF. At that time, she reported bothersome pulsatile tinnitus that she perceives on the right despite a complete hearing loss on the right side. A further intervention was declined by the patient and angiographic follow-up in one year has been scheduled
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