OBJECTIVE: We report a rare case of thrombosis of the superior sagittal sinus associated with a parafalcine meningioma resulting in a superior sagittal sinus dural arteriovenous fistula (dAVF). We conclude that dural sinus thrombosis is a significant predisposing factor for development of a dAVF. CLINICAL PRESENTATION: A 60-year-old man had a left parietal parafalcine meningioma that invaded the posterior third of his superior sagittal sinus, leading to its occlusion and presumably resulting in an associated dAVF. The fistula was fed by the middle meningeal and superficial temporal arteries on both sides and drained through a superior interhemispheric cortical vein into the vein of Galen and straight sinus. INTERVENTION AND TECHNIQUE: The parafalcine mass, which involved the sagittal sinus, was excised via a left parieto-occipital craniotomy. It was decided to resect the dAVF at a later date. Seven days after the original operation, the patient underwent a parietal interhemispheric approach for occlusion of the dAVF. Dissection proceeded until a large arterialized vein and venous pouch with multiple feeders from both external carotid arteries were observed. The vein, which was partially embedded within the falx cerebri, was collapsed, and a second indocyanine green injection confirmed cessation of blood flow. CONCLUSION: This report supports that dAVFs are acquired lesions and that venousoutflow obstruction is a significant contributing factor to their development. In meningiomas associated with the dural sinuses, diagnostic evaluation for possible dAVFs should be considered. Treatment of these lesions should be based on risk factors because spontaneous resolution after tumor excision has been reported.
OBJECTIVE: We report a rare case of thrombosis of the superior sagittal sinus associated with a parafalcine meningioma resulting in a superior sagittal sinus dural arteriovenous fistula (dAVF). We conclude that dural sinus thrombosis is a significant predisposing factor for development of a dAVF. CLINICAL PRESENTATION: A 60-year-old man had a left parietal parafalcine meningioma that invaded the posterior third of his superior sagittal sinus, leading to its occlusion and presumably resulting in an associated dAVF. The fistula was fed by the middle meningeal and superficial temporal arteries on both sides and drained through a superior interhemispheric cortical vein into the vein of Galen and straight sinus. INTERVENTION AND TECHNIQUE: The parafalcine mass, which involved the sagittal sinus, was excised via a left parieto-occipital craniotomy. It was decided to resect the dAVF at a later date. Seven days after the original operation, the patient underwent a parietal interhemispheric approach for occlusion of the dAVF. Dissection proceeded until a large arterialized vein and venous pouch with multiple feeders from both external carotid arteries were observed. The vein, which was partially embedded within the falx cerebri, was collapsed, and a second indocyanine green injection confirmed cessation of blood flow. CONCLUSION: This report supports that dAVFs are acquired lesions and that venousoutflow obstruction is a significant contributing factor to their development. In meningiomas associated with the dural sinuses, diagnostic evaluation for possible dAVFs should be considered. Treatment of these lesions should be based on risk factors because spontaneous resolution after tumor excision has been reported.
Authors: Michael E Kritikos; Martin Oselkin; Nikhil Sharma; Pallavi P Gopal; Douglas C Bigelow; Sean Grady; Robert W Hurst; Bryan A Pukenas; Omar Choudhri; David Kung Journal: Cureus Date: 2018-06-27