Successful endovascular treatment of a deep cerebral arteriovenous fistula with unusual venous drainage

Abstract

Background Cerebral arteriovenous fistula (AVF) is a rare disease. We present one adult with a deep cerebral AVF presented with cerebellar hemorrhage. Case description A 35-year-old man suddenly experienced headache, vomiting, dysarthria and ataxia of gait. Computed tomography (CT) demonstrates bilateral cerebellar hemorrhage. Angiography revealed a cerebral AVF fed by the bilateral medial posterior choroidal arteries and drained into the supratentorial deep venous system with flow into the infratentorial venous system. The draining veins included three varices, one of which, in the cerebellar vermis, was thought to be the source of bleeding. The patient was treated with transarterial embolization using n-butyl-cyanoacrylate (NBCA) and detachable platinum coils. Although coil migration during endovascular treatment occurred, complete closure of the fistula without morbidity and mortality was obtained. Conclusion Direct intracranial arteriovenous fistula with supra and infra tentorial venous drainage is rare; it can present with intracranial hemorrhage and can be treated by endovascular therapy.