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Dural Arteriovenous Fistula Could Be Due to Hemodynamic Disturbance in Dural Physiological Shunts? Histopathological
Alhusain Nagm1, Tetsuyoshi Horiuchi2, Kohei Kanaya2
1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr City, Cairo, Egypt.
Insights
Histopathologic study of a dural arteriovenous fistula (dAVF) revealed a shunt point, aiding in pathogenesis clarification. This case excluded acquired etiologies for the Cognard type IV dAVF.
Area of Science:
- Neurology
- Vascular Surgery
- Pathology
Background:
- Histopathologic examination of dural arteriovenous fistulas (dAVFs) is crucial for understanding their pathogenesis.
- This study presents a detailed histopathologic analysis of a Cognard type IV dAVF.
Observation:
- A 53-year-old man presented with chronic headache, with no neurological deficits.
- Neuroimaging and angiography revealed a left frontoparietal dAVF fed by superficial temporal and middle meningeal arteries.
- Intraoperative findings confirmed arterial supply via the superficial temporal artery and drainage into cortical and dural veins.
Findings:
- Serial section histopathology identified a distinct shunt point between the dural artery and dural vein.
- A draining point between dural and cortical veins was also histologically documented.
- The study correlated these microscopic findings with macroscopic radiologic and intraoperative observations.
Implications:
- The detailed histopathologic findings contribute to a deeper understanding of dAVF pathogenesis.
- This case report supports the exclusion of acquired etiologies in similar dAVF presentations.
- Correlating histopathology with clinical and imaging data enhances diagnostic and therapeutic strategies for dAVFs.
Background:
Histopathologic studies of dural arteriovenous fistulas (dAVFs) are important for clarifying the pathogenesis. We present a case of Cognard type IV dAVF with detailed histopathologic studies in correlation with radiologic and intraoperative findings.
Case Description:
An otherwise asymptomatic 53-year-old man presented with chronic headache. Neurologic examination revealed no abnormalities. Neuroimaging and cerebral catheter angiographic studies disclosed a left frontoparietal dAVF close to the middle third of the superior sagittal sinus, fed by the left superficial temporal and bilateral middle meningeal arteries and draining into ectatic cortical and dural veins. No evidence of superior sagittal sinus thrombosis or occlusion was seen. Intraoperatively, the parietal branch of the left superficial temporal artery penetrated the skull vault to feed the fistula; arterialized cortical and draining dural veins were also noted. Complete obliteration of the dAVF with removal of the affected dura mater was achieved safely. Histopathologic studies in serial sections documented a shunt point between the dural artery and the dural vein within the dura mater and a draining point between the dural and cortical veins.
Conclusions:
On the basis of clinical, angiographic, intraoperative, and histologic findings in our case, we strongly excluded acquired etiologies.
