くも膜下出血で発症したextrasinusal typeの後頭蓋窩硬膜動静脈瘻の1例

Abstract

We report an 80-year-old male with posterior cranial fossa “extrasinusal type” dural arteriovenous fistula (dAVF) presenting with subarachnoid hemorrhage (SAH) and subsequent rebleeding. He complained of sudden occipitalgia. Although head computed tomography (CT) scan revealed SAH localized to the right cerebello-pontine cistern, neither internal carotid angiograms nor vertebral angiograms showed any vascular abnormalities. He presented with sudden headache again and slight disturbance of consciousness four days after the onset of headache. A repeated CT scan revealed SAH due to rebleeding. Right external carotid angiograms showed a dAVF which was fed mainly by the middle meningeal artery and the occipital artery, and draining directly into the petrosal vein. The draining vein had a varix that was thought to be the bleeding point. The patient underwent surgical interruption of the draining vein. Postoperative angiograms showed complete obliteration of the fistula. The petrosal vein-draining dAVF, which is an “extrasinusal type” dAVF according to Lasjaunias’ classification, presents a high risk of intracranial hemorrhage. Therefore, they should be completely cured with surgical interruption of the retrograde venous drainage as early as possible.