[A neonate case of dural arteriovenous shunt presenting with cerebellar hemorrhage]

A rare case of dural arteriovenous shunt (dAVS) manifested as cerebellar hemorrhage in a neonate is reported. Seven days after birth, a neonate was referred to our hospital because of consciousness disturbance. CT scan revealed cerebellar hemorrhage, subarachnoid hemorrhage, subdural hematoma, and a high density mass lesion at the torcular herophili. Retrograde brachial angiogram failed to show any vascular lesions. He underwent an evacuation of the cerebellar hematoma. Postoperative course was uneventful. However, at the age of four months, he was admitted again because of consciousness disturbance and cardiac failure. CT scan revealed hydrocephalus and an enlarged mass lesion at the torcular herophili. Angiogram disclosed dural AVS. Its feeding arteries were as follows; the bilateral middle meningeal arteries (MMA), the occipital arteries (OA), dural branches of the bilateral posterior inferior cerebellar arteries, arteries consisting of transdural anastomosis from the left posterior cerebral artery. The arterial flow from these feeding arteries was shunting directly to the torcular herophili, the posterior part of the superior sagittal sinus, and the straight sinus. He underwent a venticulo-peritoneal shunting. Then, after treatment for cardiac failure, superselective embolization of the bilateral MMAs and the OAs resulted in diminution of shunting flow. The initial onset of this case was at seven days after his birth. Dural AVS is very rare in the pediatric population, particularly in the neonate. The clinical features, pathogenesis, and the treatment for this rare entity are discussed.