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Tentorial dural fistula with giant venous ampulae treated with embolisation and surgery. A case report.
Acta Neurochir (Wien). 2010 Oct; 152(10):1745-53.AN

Abstract

Tentorial dural arteriovenous fistulas are rare and complex lesions in deep locations with unusual vascular anatomy and critical surrounding neuroanatomy. A rare case presenting a complex fistula with a giant venous draining ampulae, causing headaches and visual troubles is presented. We describe the case of a 52-year-old woman admitted in our department for headaches and visual troubles. Magnetic resonance imaging and cerebral angiography showed a tentorial dural arteriovenous fistula draining in a giant tentorial venous ampulae and leptomeningeal veins. The patient was embolised via an arterial route with a good clinical and radiological result. However, 4 days later she presented a sudden change of her clinical status with coma, left hemiparesis and a right midriasis. The cerebral computed tomography scan showed a huge occipital haemorrhagic mass and a severe cerebral oedema. An emergent surgical procedure was decided realising evacuation of the occipital haematoma and a complete resection of the giant venous ampoule. The neck of the ampulae was sutured and clipped at its dural entrance. Postoperatively a new embolisation was realised because of persistent of a small dural fistulae with occipital leptomeningeal drainage. The patient recovered rapidly with only a residual hemianopsy. Treatment of dural AV malformation represent a serious challenge. Our report describes an unusual case of a tentorial dural complex fistula treated by an endovascular procedure with secondary clinical aggravation that needed emergent surgical therapy. Even in a case for good immediate radiological result after endovascular procedure, dural arteriovenous fistulas with giant venous ampulae and important venous engorgement, need closed follow-up, because of the possibility of aggravation secondary to venous thrombosis and haemorrhage. Treatment and patophysiology of the aggravation mechanism are discussed.

Authors+Show Affiliations

Neurosurgical Department, University Hospital, CHU Caen, France. alin_borha@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

20635104

Citation

Borha, Alin, et al. "Tentorial Dural Fistula With Giant Venous Ampulae Treated With Embolisation and Surgery. a Case Report." Acta Neurochirurgica, vol. 152, no. 10, 2010, pp. 1745-53.
Borha A, Emery E, Courtheoux P, et al. Tentorial dural fistula with giant venous ampulae treated with embolisation and surgery. A case report. Acta Neurochir (Wien). 2010;152(10):1745-53.
Borha, A., Emery, E., Courtheoux, P., Lefevre, P., & Derlon, J. M. (2010). Tentorial dural fistula with giant venous ampulae treated with embolisation and surgery. A case report. Acta Neurochirurgica, 152(10), 1745-53. https://doi.org/10.1007/s00701-010-0722-6
Borha A, et al. Tentorial Dural Fistula With Giant Venous Ampulae Treated With Embolisation and Surgery. a Case Report. Acta Neurochir (Wien). 2010;152(10):1745-53. PubMed PMID: 20635104.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tentorial dural fistula with giant venous ampulae treated with embolisation and surgery. A case report. AU - Borha,Alin, AU - Emery,Evelyne, AU - Courtheoux,Patrick, AU - Lefevre,Pascal, AU - Derlon,Jean Michel, Y1 - 2010/07/16/ PY - 2010/02/28/received PY - 2010/06/14/accepted PY - 2010/7/17/entrez PY - 2010/7/17/pubmed PY - 2011/6/3/medline SP - 1745 EP - 53 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 152 IS - 10 N2 - Tentorial dural arteriovenous fistulas are rare and complex lesions in deep locations with unusual vascular anatomy and critical surrounding neuroanatomy. A rare case presenting a complex fistula with a giant venous draining ampulae, causing headaches and visual troubles is presented. We describe the case of a 52-year-old woman admitted in our department for headaches and visual troubles. Magnetic resonance imaging and cerebral angiography showed a tentorial dural arteriovenous fistula draining in a giant tentorial venous ampulae and leptomeningeal veins. The patient was embolised via an arterial route with a good clinical and radiological result. However, 4 days later she presented a sudden change of her clinical status with coma, left hemiparesis and a right midriasis. The cerebral computed tomography scan showed a huge occipital haemorrhagic mass and a severe cerebral oedema. An emergent surgical procedure was decided realising evacuation of the occipital haematoma and a complete resection of the giant venous ampoule. The neck of the ampulae was sutured and clipped at its dural entrance. Postoperatively a new embolisation was realised because of persistent of a small dural fistulae with occipital leptomeningeal drainage. The patient recovered rapidly with only a residual hemianopsy. Treatment of dural AV malformation represent a serious challenge. Our report describes an unusual case of a tentorial dural complex fistula treated by an endovascular procedure with secondary clinical aggravation that needed emergent surgical therapy. Even in a case for good immediate radiological result after endovascular procedure, dural arteriovenous fistulas with giant venous ampulae and important venous engorgement, need closed follow-up, because of the possibility of aggravation secondary to venous thrombosis and haemorrhage. Treatment and patophysiology of the aggravation mechanism are discussed. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/20635104/Tentorial_dural_fistula_with_giant_venous_ampulae_treated_with_embolisation_and_surgery__A_case_report_ L2 - https://dx.doi.org/10.1007/s00701-010-0722-6 DB - PRIME DP - Unbound Medicine ER -