1. Dural arteriovenous fistula of the torcular herophili presenting with hydrocephalus and venous congestion in an 8-month-old child: A case report
- Author
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Dimitri T K. Ndandja, Gerald Musa, Rossi E C. Barrientos, Matvey I Livshitz, Suzy N J. Manko, Gennady E Chmutin, Hovrin V Dmitri, Bupe M Mwela, and Slabov V Mihail
- Subjects
cerebral vascular malformations ,confluence of sinuses ,dura arteriovenous fistula ,dural arteriovenous fistulas ,embolization ,hydrocephalus ,Medical technology ,R855-855.5 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Dural arteriovenous fistulas (DAVFs) are direct communication between the dural arterial and venous systems. They are more common in adults. In children, they are relatively rare. Hydrocephalus is a common problem in pediatrics with a variety of causes. However, very few cases of hydrocephalus as a complication of DAVF have been reported in the literature. This case describes an 8-month-old male child with a large DAVF at the torcular herophili who presented with regression of milestones and hydrocephalus. Magnetic resonance imaging (MRI) on admission showed triventricular hydrocephalus and a massively dilated torcular with a compressed fourth ventricle. Angiography confirmed the presence of a DAVF at the torcula with arterial feeders from the posterior circulation. Endovascular embolization was performed with >80% embolization of the fistula with no complications. Control MRI immediately postoperative was acceptable. No cerebrospinal fluid (CSF) diversion was performed. At a 3-month follow-up, the child had attained all developmental milestones for age. MRI showed normal CSF dynamics and a further reduction in the size of the torcula. Despite being rare, DAVFs should be considered as a possible cause of pediatric hydrocephalus, and treating them can lead to a resolution of the mechanisms inducing hydrocephalus. CSF shunting should be reserved for those cases with persistent hydrocephalus and raised intracranial pressure despite endovascular treatment.
- Published
- 2023
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