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Case series
Anticoagulation helps shrink giant venous lakes and arteriovenous fistulas in dural sinus malformation
  1. Guillaume Saliou1,2,
  2. Kumaran Deiva3,
  3. Markus A Möhlenbruch4,
  4. Boris Lubicz5
  1. 1Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  2. 2UNIL, Lausanne, Switzerland
  3. 3Service de Neuropédiatrie, Hôpital Bicêtre Service de Neuropédiatrie, Le Kremlin-Bicetre, France
  4. 4Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
  5. 5Diagnostic and Interventional Neuroradiology, Hôpital Universitaire Erasme, Bruxelles, Belgium
  1. Correspondence to Professor Guillaume Saliou, Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Vaud, Switzerland; Guillaume.Saliou{at}


Background Dural sinus malformations (DSMs) associated with high flow arteriovenous shunts are a challenging disease in babies that can lead to severe neurological damage or death. We report our treatment strategy in seven consecutive DSMs.

Methods We performed a retrospective analysis of seven consecutive patients from four centres, treated with transarterial embolization and anticoagulants.

Results Mean clinical and imaging follow-up was 2.8 years (IQR1–3 1.8–5.3). At baseline, the median size of the dilated venous pouch (giant lake) was 35 mm (IQR1–3 24–41) that decreased to a normal or near normal venous collector diameter of median size 11.5 mm (IQR1–3 8.5–13.8). This was achieved after a median of two embolization sessions targeted on dural feeders (IQR1–3 1.5–2.5), leaving associated pial feeders untreated. There were no cerebral hemorrhagic complications during the anticoagulation treatment. Median percentage of shunt remaining after embolization was 30% (IQR1–3 12–30), which spontaneously decreased with anticoagulation and even after discontinuation of anticoagulation, in parallel with the reduction in diameter of the dilated sinus, up to healing (or near healing). At the last clinical assessment, the modified Rankin Scale score was 0 in four patients, 1 in one patient, and 3 in two patients.

Conclusions Anticoagulants may help to potentiate transarterial embolization in DSMs in babies by decreasing venous dilatation and reducing the remaining arteriovenous shunt, particularly the pial feeders. We did not observe recurrence of arteriovenous shunts after treatment, especially during anticoagulation treatment. Further studies are needed to support our findings.

  • Pediatrics
  • Vascular Malformation

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  • Contributors GS contributed to conception and design of the study and prepared the figures. All authors contributed to acquisition of the data, analysis of the data, and drafting the text.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.