EURORAD ESR

Case 14602

Dural falco-tentorial arteriovenous fistula

Author(s)
Morandeira C, Manso X, Lopez A, Gómez JJ, Peña B, Grau M, Gonzalez de Garay M.

H.U. de Basurto; Spain; Email:morandeiraclara@gmail.com
 
Patient
male, 51 year(s)
 
 
  • Figure 1
    Brain CT
     

    Non-contrast CT axial image discloses an spontaneous hiperdense tubular mass in the falx causing incipient hydrocephalux.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Non-contrast CT axial shows enlargement of vascular foramina in the skull.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Axial CT angiography demonstrates the presence of a vascular malformation.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 2
    CT postprocessing images
     

    Volume rendering image depict dilated extracranial arteries that are branches from external carotid artery and supply the lesion.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Image manipulation / Reconstruction; Procedure: Computer Applications-3D; Special Focus: Fistula;

    Major intensity Projection (MIP) image shows clustered vessels surrounding straight sinus and Gallen vein, accompanied by venous ectasia.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Image manipulation / Reconstruction; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 3
    Brain MRI
     

    T2 blade axial image with hipointense tubular structures corresponding to vascular malformation.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Fistula;

    T2 blade axial image with hipointense tubular structures corresponding to vascular malformation.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 4
    Digital substraction right external carotid arteriography
     

    Frontal right external carotid angiogram demostrates supplies from the middle meningeal artery.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Lateral right external carotid angiogram supports the middle meningeal artery supply and drainage to Gallen vein and straight sinus with internal cerebral veins reflux.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 5
    Digital substraction left occipital arteriography
     

    Frontal left occipital carotid angiogram shows transforaminal supply to the fistula.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Lateral left occipital artery angiogram depicts a falcine arterial supply to the fistula and early venous drain.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 6
    Digital subtraction left internal carotid arteriography
     

    Frontal left internal carotid angiogram depicts posterior meningeal artery supply with anomalous ascending pharyngeal artery origin in internal carotid. Early vein drain and vein reflux are also demonstrate.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Lateral left internal carotid angiogram confirms posterior meningeal artery supply.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 7
    Digital subtraction right internal carotid arteriography
     

    Frontal right internal carotid angiogram in venous phase reveals absence of internal venous flow due to its early drain to cavernous sinus via lenticulostriate vein.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Lateral right internal carotid angiogram in venous phase confirms the vein flux anomaly.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 8
    Endovascular therapy
     

    Frontal fluoroscopy view of Onix embolic material within arterio-venous dural fistula.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Fistula;

    Lateral fluoroscopy view of Onix treatment.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Fistula;
     
     
  • Figure 9
    Brain MRI Follow-up
     

    T1 VIBE after Gadolinium enhancement axial image shows hipointense area due to Onyx and reveals little and persistent anterior arterial supply.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR-Angiography; Procedure: Diagnostic procedure; Special Focus: Fistula;

    SWI axial image depicts hipointense area secondary to Onyx.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
Non-contrast CT axial image discloses an spontaneous hiperdense tubular mass in the falx causing incipient hydrocephalux.
 
Non-contrast CT axial shows enlargement of vascular foramina in the skull.
 
Axial CT angiography demonstrates the presence of a vascular malformation.
 
Volume rendering image depict dilated extracranial arteries that are branches from external carotid artery and supply the lesion.
 
Major intensity Projection (MIP) image shows clustered vessels surrounding straight sinus and Gallen vein, accompanied by venous ectasia.
 
T2 blade axial image with hipointense tubular structures corresponding to vascular malformation.
 
T2 blade axial image with hipointense tubular structures corresponding to vascular malformation.
 
Frontal right external carotid angiogram demostrates supplies from the middle meningeal artery.
 
Lateral right external carotid angiogram supports the middle meningeal artery supply and drainage to Gallen vein and straight sinus with internal cerebral veins reflux.
 
Frontal left occipital carotid angiogram shows transforaminal supply to the fistula.
 
Lateral left occipital artery angiogram depicts a falcine arterial supply to the fistula and early venous drain.
 
Frontal left internal carotid angiogram depicts posterior meningeal artery supply with anomalous ascending pharyngeal artery origin in internal carotid. Early vein drain and vein reflux are also demonstrate.
 
Lateral left internal carotid angiogram confirms posterior meningeal artery supply.
 
Frontal right internal carotid angiogram in venous phase reveals absence of internal venous flow due to its early drain to cavernous sinus via lenticulostriate vein.
 
Lateral right internal carotid angiogram in venous phase confirms the vein flux anomaly.
 
Frontal fluoroscopy view of Onix embolic material within arterio-venous dural fistula.
 
Lateral fluoroscopy view of Onix treatment.
 
T1 VIBE after Gadolinium enhancement axial image shows hipointense area due to Onyx and reveals little and persistent anterior arterial supply.
 
SWI axial image depicts hipointense area secondary to Onyx.
 
 
 
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