P004/33 Recurrent intracranial hypertension secondary to collateral regression following successful occlusion of dural AV fistula

PresentationA 35 year-old lady presented with headache, tinnitus and papilloedema. LP showed raised CSF pressure. Acetazolamide was commenced for presumed idiopathic intracranial hypertension with atypical phenotype but papilloedema persisted despite increasing dosage.CTV showed a non-occlusive right sigmoid sinus filling defect with bilateral transverse sinus stenosis. Prominent, tortuous veins straddled the tentorium, indicating venous hypertension.Angiography identified a dural A-V fistula involving the torcula and right transverse sinus. Tributaries included bilateral MMA and occipital artery branches, bilateral posterior meningeal branches via vertebral arteries, tentorial PCA branches, meningo-hypophyseal/inferolateral trunk and distal PCA branches. The transverse sinus, posterior aspect of superior sagittal sinus and straight sinus drained the fistula exclusively.InterventionThe fistula was embolised in two stages. At first stage, detachable coils were deployed along the right transverse sinus and Onyx18 was injected trans-arterially into the right middle meningeal and occipital feeders. At second stage, Onyx18 was injected into the right occipital artery feeders with good fistula/feeder penetration and satisfactory angiographic result.Follow-UpHeadaches and tinnitus due to fistula-induced raised ICP initially resolved but headaches recurred after a few months, again with raised CSF pressure. Angiography showed fistula resolution but with regression of the collateral v...
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: 4.2 CASE PROPOSAL - Brain AVM/AVF, spinal vascular malformations Source Type: research