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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Acquired Chiari Type I Malformation Associated with Type IV Dural Arteriovenous Fistula: Case Report
Diego D Luy1, Nitin Agarwal1, Michael M McDowell1
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Background:
Chiari malformations, usually congenital, can rarely be associated with arteriovenous (AV) fistulas. We present the first case involving a type IV dural AV fistula with a Chiari type I malformation.
Methods:
Retrospective chart review was performed to obtain pertinent details regarding history and examination, pathologic findings, and treatment course.
Results:
A 63-year-old woman with a 2-year history of migraines presented with 5 months of occipital, right-sided headaches and neck pain exacerbated by Valsalva maneuvers. Computed tomography (CT) and magnetic resonance imaging (MRI) of the head showed a possible right occipital AV malformation, bilateral cerebellar subdural hygromas, and tonsillar crowding at the foramen magnum indicating an acquired Chiari type I malformation. Angiography demonstrated a Cognardtype IV right posterior occipital dural AV fistula supplied by bilateral middle meningeal and posterior meningeal arteries.
Conclusion:
After treatment of the dural AV fistula, hygroma evacuation, and decompression of the acquired Chiari malformation, the patient's Valsalva-induced headaches abated.
