Spontaneous CSF Leak Complicated by Venous Thrombosis and Dural Arteriovenous Fistula

The authors present a case of spinal dural arteriovenous fistula with fluctuations in symptoms following embolization. Superselective injection of 33% N-butyl cyanoacrylate into the feeding vessel resulted in the complete occlusion of the fistula with traversal of the nidus. The subsequent venous congestion was progressive and treatable with anti-thrombin therapy. Extended medication with dual antiplatelet therapy was required because dose reduction to aspirin monotherapy worsened symptoms. In this case, it took > 2 months for the patient's symptoms to stabilize. The duration of progressive venous thrombosis after embolization of a spinal dural arteriovenous fistula is not well known, nor is the most adequate treatment. Although it is presumed that prevention of venous thrombosis is best achieved with anticoagulation, dual antiplatelet therapy can be a substitute for patients with poor compliance.

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Dural arteriovenous fistula and cerebral venous thrombosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150050 ◽

2015 ◽

Vol 73 (6) ◽

pp. 548-548 ◽

Cited By ~ 2

Author(s):

Adriana Bastos Conforto ◽

Saulo Nardy Nader ◽

Paulo Puglia Junior ◽

Fabio Iuji Yamamoto ◽

Marcia Rubia Rodrigues Gonçalves ◽

...

Keyword(s):

Venous Thrombosis ◽

Arteriovenous Fistula ◽

Cerebral Venous Thrombosis ◽

Dural Arteriovenous Fistula

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Type I Dural Arteriovenous Fistula Mimicking Dural Venous Thrombosis–Related Intracranial Hypertension

Journal of Neuro-Ophthalmology ◽

10.1097/wno.0000000000000574 ◽

2017 ◽

Vol 37 (4) ◽

pp. 460-462

Author(s):

Hang Pham ◽

Sangeeta Khanna

Keyword(s):

Venous Thrombosis ◽

Intracranial Hypertension ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Type I

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Secondary Clinical Deterioration after Successful Embolization of a Spinal Dural Arteriovenous Fistula: A Plea for Prophylactic Anticoagulation

Interventional Neuroradiology ◽

10.1177/159101991001600213 ◽

2010 ◽

Vol 16 (2) ◽

pp. 199-203 ◽

Cited By ~ 15

Author(s):

J. Knopman ◽

W. Zink ◽

A. Patsalides ◽

H.A. Riina ◽

Y.P. Gobin

Keyword(s):

Venous Thrombosis ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Spinal Dural Arteriovenous Fistula ◽

Adequate Treatment ◽

Av Fistula ◽

Time Period ◽

Systemic Anticoagulation ◽

Prophylactic Anticoagulation ◽

Spinal Dural Av Fistula

We present a case of delayed aggravation of initially-resolved symptoms in a patient after successful embolization of a T5 spinal dural arteriovenous (AV) fistula with N-butyl cyanoacrylate. The symptoms were attributed to venous thrombosis and resolved with systemic anticoagulation after five days of treatment. Although the most adequate treatment for preventing venous thrombosis after spinal dural AV fistula is not known, we describe this patient as a case for more aggressive prophylactic anticoagulation measures in the immediate post-embolization time period.

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Spinal dural arteriovenous fistula rupture after Rathke’s cleft cyst endoscopic resection: Case report and literature review

Surgical Neurology International ◽

10.25259/sni_654_2021 ◽

2021 ◽

Vol 12 ◽

pp. 455

Author(s):

Jefferson Trivino-Sanchez ◽

Pedro Henrique Costa Ferreira-Pinto ◽

Elington Lannes Simões ◽

Felipe Gonçalves Carvalho ◽

Diego Rodrigues Menezes ◽

...

Keyword(s):

Visual Acuity ◽

Arteriovenous Fistula ◽

Endoscopic Resection ◽

Dural Arteriovenous Fistula ◽

Fatal Case ◽

Csf Leak ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Spinal Dural Arteriovenous Fistula ◽

Rathke's Cleft

Background: Spinal dural arteriovenous fistula (SDAVF) is the most frequent vascular malformation of the spine and accounts for approximately 70% of all vascular spinal malformations. In rare cases, SDAVF rupture and subsequent subarachnoid hemorrhage or intramedullary hematoma may occur. The aim of this article is to present a fatal case of SDAVF rupture after a Rathke’s cleft cyst (RCC) endoscopic resection. Case Description: An 80-year-old female was referred to our hospital with a clinical presentation of bilateral reduction in visual acuity, bitemporal hemianopsia, and sellar magnetic resonance imaging (MRI) highly suggestive of RCC. After the first endonasal endoscopic surgery, the cyst was partially removed and vision improved. No signs of cerebrospinal fluid (CSF) leak were observed. After 1 year, the patient returned because of RCC recurrence and decreased visual acuity. In the second procedure, the lesion was totally resected and CSF leak was observed. A nasoseptal flap was rotated to cover the skull base defect. The patient developed subtle paraparesis followed by paraplegia on the 4th postoperative day. The dorsal spine MRI revealed a T3-T4 intramedullary hematoma. A dorsal laminectomy was performed and a SDAVF was observed. During microsurgery, at the right T3 nerve root level, an arteriovenous shunting point was identified, coagulated, and divided. The intramedullary hematoma was evacuated. The patient developed neurogenic and septic shock and died. Conclusion: Venous hypertension, venous wall fragility, and venous thrombosis seem to be the main factors involved in SDAVF rupture. In this particular case, reduction of the extravascular pressure and sudden variation in the pressure gradient caused by sustained CSF leak, also appeared to play an important role in SDAVF rupture. It may represent one more complication related to radical resection of RCC.

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