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Varix Rupture Due to High-Flow Parasagittal Sinus Dural Arteriovenous Fistula: A Case Report and Literature Review

Koji Hirata1,2, Kyoji Tsuda2, Keishi Fujita2

  • 1Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN.

Cureus
|June 10, 2025
PubMed

Insights

Parasagittal sinus dural arteriovenous fistulas (DAVFs) can cause dangerous intracranial hemorrhage (ICH). Even with successful embolization, outcomes for these aggressive vascular malformations can be poor.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Radiology

Background:

  • Parasagittal sinus dural arteriovenous fistulas (DAVFs) are uncommon yet aggressive vascular lesions.
  • These malformations carry a significant risk of causing intracranial hemorrhage (ICH).

Observation:

  • A case is presented of a 75-year-old male experiencing altered consciousness, anisocoria, and hemiparesis.
  • Imaging revealed a ruptured varix linked to a parasagittal sinus DAVF (Cognard type IV, Borden type III) as the cause of a large subcortical ICH.

Findings:

  • The patient underwent emergency hematoma evacuation and successful transarterial embolization via the contralateral middle meningeal artery (MMA) using N-butyl-2-cyanoacrylate.
  • Despite complete angiographic obliteration of the DAVF, the patient's clinical outcome was unfavorable.

Implications:

  • Parasagittal sinus DAVFs must be considered in the differential diagnosis for patients presenting with large subcortical hemorrhages.
  • Contralateral MMA embolization is a viable treatment option when ipsilateral arterial access is not feasible.
  • Certain DAVF cases may lead to poor clinical outcomes despite effective treatment.
Keywords:
cortical venous refluxdural arteriovenous fistula (davf)subcortical hemorrhagesuperior sagittal sinusvarix

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