De novo aneurysm formation of a feeder artery after embolization of a dural arteriovenous fistula and rupture during second embolization

Abstract

Objective

Hemorrhage during embolization of dural arteriovenous fistula (DAVF) is a rare but devastating complication. This study was undertaken to analyze the causes of hemorrhage and avoid complication.

Methods

The clinical data of a case of DAVF with hemorrhagic complication were retrospectively collected and analyzed.

Results

The patient in this case presented with DAVF and two de novo aneurysms of a feeder artery after the first embolization. One de novo aneurysm ruptured during the second embolization of the DAVF because of hemodynamic change. Computed tomography showed a subdural hematoma, and surgical exploration was emergently performed. However, the patient died at postoperative day 10.

Conclusions

De novo aneurysm of a feeder artery may form after embolization of DAVF because of hemodynamic change. It has a high risk of rupture and should be a primary consideration in embolization of DAVF.

Keywords

Dural arteriovenous fistula endovascular Onyx de novo aneurysm hemorrhage

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References

Al-Shahi

Bhattacharya

Currie

et al.

Prospective, population-based detection of intracranial vascular malformations in adults: The Scottish Intracranial Vascular Malformation Study (SIVMS). Stroke 2003; 34: 1163–1169.

Hacein-Bey

Konstas

Pile-Spellman

. Natural history, current concepts, classification, factors impacting endovascular therapy, and pathophysiology of cerebral and spinal dural arteriovenous fistulas. Clin Neurol Neurosurg 2014; 121: 64–75.

Piippo

Niemelä

. Hemodynamic changes caused by the occlusion of dural arteriovenous fistula. World Neurosurg 2013; 80: e211–e212.

Gonzalez

Chalouhi

Jabbour

et al.

Rapid and progressive venous thrombosis after occlusion of high-flow arteriovenous fistula. World Neurosurg 2013; 80: e359–e365.

Lee

Chen

Hsu

. Cerebellar hemorrhage and subsequent venous infarction followed by incomplete transvenous embolization of dural carotid cavernous fistulas: A rare complication: Case report. J Neurosurg 2008; 108: 1245–1248.

de Carvalho

Machin

Manzanera

et al.

Intraventricular hemorrhage after dural fistula embolization. Braz J Anesthesiol 2017; 67: 199–204.

Kakarla

Deshmukh

Zabramski

et al.

Surgical treatment of high-risk intracranial dural arteriovenous fistulae: Clinical outcomes and avoidance of complications. Neurosurgery 2007; 61: 447–459.

Koroknay-Pál

Niemelä

Lehto

et al.

De novo and recurrent aneurysms in pediatric patients with cerebral aneurysms. Stroke 2013; 44: 1436–1439.

Morita

. Current perspectives on the unruptured cerebral aneurysms: Origin, natural course, and management. J Nippon Med Sch 2014; 81: 194–202.

10.

Kohyama

Yamane

Ishihara

et al.

Rupture of an aneurysm of the superior cerebellar artery feeding a dural arteriovenous fistula. J Stroke Cerebrovasc Dis 2015; 24: e105–e107.

11.

Sato

Matsumoto

Endo

et al.

A hemorrhagic complication after Onyx embolization of a tentorial dural arteriovenous fistula: A caution about subdural extension with pial arterial supply. Interv Neuroradiol 2017; 23: 307–312.

12.

Zhang

Wang

et al.

Onyx embolization for tentorial dural arteriovenous fistula with pial arterial supply: Case series and analysis of complications. World Neurosurg 2016; 92: 58–64.