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Abstract
Introduction/Purpose A dural arteriovenous fistula (dAVF) is an abnormal vascular connection between an artery and vein in the dura mater of the brain or spinal cord. dAVF may cause symptoms such as headaches or seizures and may be fatal if they rupture. Standard dAVF treatment options include endovascular procedures, stereotactic radiosurgery (such as gamma knife), or surgery. Bilateral dAVFs, as opposed to unilateral, are a very rare occurrence. We report a case of a 43-year-old male patient with bilateral dAVF treated with gamma knife radiosurgery.
Materials and Methods This study consists of a retrospective, single-center patient case report assessing the management and outcomes of gamma knife radiosurgery in a patient with bilateral dAVF. Consent to publish this deidentified case report was obtained. We plan to soon conduct a systematic review to combine with this case report to expand into a conceptualized manuscript.
Results A 43-year-old male patient initially presented to the Neurology clinic with complaints of headaches and tinnitus in the setting of cerebral venous sinus thrombosis and Factor V Leiden, on a regimen of apixaban 2.5 mg BID. He was thereafter referred to our Neurosurgery department in August 2019, where an angiography was performed, demonstrating bilateral dAVF with retrograde cerebral venous drainage and bilateral functioning internal jugular veins (figure 1), despite MRI/MRA and CTA not clearly demonstrating a fistula. The bilateral dAVF were not safely amenable to microsurgery nor embolization via the internal jugulars. After review at a multi-disciplinary conference, the patient was treated with gamma knife radiosurgery in January 2020. Thereafter, his headaches and tinnitus completely resolved, and he continued his daily activities without complaints. 28 months later, while continuing apixaban, an angiogram showed complete obliteration of both dAVF. MRI/MRA was scheduled to be acquired five years out for follow-up; however, the patient was instructed to return to clinic sooner should any symptoms remerge or develop.
Conclusion Gamma knife radiosurgery appears to be an effective treatment modality for bilateral dAVF. We encourage further investigation regarding the efficacy and outcomes of different treatment modalities for bilateral dAVF as well as the epidemiology of bilateral dAVF.
Disclosures T. Eatz: None. A. Metzler: None. A. Abdelsalam: None. R. Starke: None.