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Pediatric Traumatic Dural Arteriovenous Fistula

Published online by Cambridge University Press:  02 December 2014

Michael Vassilyadi ,
Naveen Mehrotra ,
Mohammed F. Shamji  and
Jean Michaud
Michael Vassilyadi*
Affiliation:
Division of Neurosurgery, Children's Hospital of Eastern Ontario Division of Neurosurgery, The Ottawa Hospital, Ottawa, Canada
Naveen Mehrotra
Affiliation:
Division of Neurosurgery, Children's Hospital of Eastern Ontario
Mohammed F. Shamji
Affiliation:
Division of Neurosurgery, The Ottawa Hospital, Ottawa, Canada
Jean Michaud
Affiliation:
Division of Anatomic Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Canada
*
The Children’s Hospital of Eastern Ontario, Division of Neurosurgery, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
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Abstract

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Background:

Dural arteriovenous fistulas are uncommon lesions in children, with traumatic lesions suspected to arise from incomplete arterial injury in proximity to a vein or draining sinus. Management of symptomatic acquired lesions requires evaluation of patient presentation, neurological status, and pathoanatomic configuration, with special consideration required for surgery secondary to failed endovascular technique.

Case Report:

A 12-year-old male sustained a bicycle fall causing a right temporo-parietal skull fracture associated with non-surgical right epidural hematoma and left contre-coup parietal contusion. Six-weeks later, he complained of a right temporal bruit with subsequent cerebral angiography demonstrating a dural-based fistula between the right middle meningeal artery and a dural vein draining into the sigmoid sinus.

Intervention:

Endovascular treatment of this lesion with glue embolization and coiling was unsuccessful, with angiographic illustration of previously unobserved collateral vessels and coils occupying the sigmoid sinus. A right temporo-parietal craniectomy was required to excise the dural-based fistula, followed by dural defect repair with bovine pericardium and subsequent cranioplasty. Six years later the patient remains neurologically intact with no headaches or bruit.

Conclusions:

Dural arteriovenous fistula can uncommonly occur following traumatic injury in children. Partial injury to the middle mengineal artery may have established arterial communication with the draining vein that became ectatic and tortuous under high pressure. Failure of primary endovascular treatment may complicate secondary surgical intervention.

Type
Other
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 6 , November 2009 , pp. 751 - 756
Copyright
Copyright © The Canadian Journal of Neurological 2009

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