[Childhood transverse sinus dural arteriovenous fistula treated with endovascular and direct surgery: a case report]
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Updated: May 17, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Kuniyasu Niizuma1, Hiroyuki Sakata, Shinya Koyama
1Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai-City, Miyagi, Japan.
Insights
Infantile dural arteriovenous fistula (iAVF) is rare. A combined endovascular and surgical approach effectively treated a recurrent case, improving epilepsy symptoms.
Area of Science:
- Neurology
- Vascular Surgery
- Pediatric Neurosurgery
Background:
- Infantile dural arteriovenous fistula (iAVF) is a rare cerebrovascular malformation with a historically poor prognosis and low cure rates.
- Current treatments, primarily endovascular embolization, aim for complete anatomical cure and normal patient development.
Observation:
- A 20-month-old girl presented with epilepsy secondary to a right transverse sinus dural arteriovenous fistula.
- Initial transvenous embolization with platinum coils provided temporary epilepsy relief but did not achieve complete shunt occlusion.
Findings:
- Recurrence of epilepsy and increased shunt flow were observed nine months post-embolization.
- A multimodal treatment strategy involving transarterial embolization and surgical resection of the affected sinus ultimately eliminated shunt flow and significantly improved epilepsy.
Implications:
- Combined endovascular and surgical treatment may be a superior strategy for managing recurrent infantile dural arteriovenous fistulas.
- This case highlights the potential for improved outcomes with aggressive, multi-modal intervention in complex pediatric cerebrovascular malformations.
Abstract:
Infantile dural arteriovenous fistula is a rare cerebrovascular malformation carrying a poor prognosis with an anatomic cure of only 9%. Endovascular embolization is mainly selected to treat this entity, aiming to obtain normal development of the patients. We present a case of a 20-month-old girl with epilepsy. Digital subtraction angiography revealed a dural arteriovenous fistula involving the right transverse sinus. The arteriovenous fistula was fed by multiple dural branches from the middle meningeal, occipital, meningohypophyseal, and anteroinferior cerebellar arteries. The right transverse sinus was transvenously embolized with platinum coils. Although the shunt flow remained, the patient was liberated from epilepsy. Nine months later, the patient suffered from a recurrence of epilepsy. Digital subtraction angiography demonstrated some increase in shunt flow. Right middle meningeal, occipital, posterior deep temporal, and tentorial arteries were transarterially embolized using N-butyl cyanoacrylate, followed by complete surgical resection of the right transverse sinus. The shunt flow disappeared after surgery, and her epilepsy improved significantly. Our experience suggests that the combination of endovascular and surgical treatment is effective for recurrent infantile dural arteriovenous fistula.