Abstract
A 65-year-old female patient presented with refractory trigeminal neuralgia causally related to a dural arteriovenous fistula (DAVF) located at the petrous apex with venous dilatation and contact with the trigeminal nerve in the cisternal course. Endovascular treatment was performed using transarterial Squid embolization via the petrous branch of the middle meningeal artery (MMA) but did not result in a complete occlusion. Therefore, this was followed by transvenous embolization with Squid via the superior petrosal sinus. Following the intervention, the patient became less alert. A CT scan showed fresh subarachnoid blood and progressive hydrocephalus over the following hours. The patient was re-intubated and given external ventricular drainage. MR imaging revealed marked edema in the brainstem and in the anterior portions of the cerebellum, which was interpreted as a venous infarction due to the occlusion of the superior petrosal vein. Therapeutic heparinization was initiated. Gradually, the patient became more alert and her edema resolved. Petrosal DAVFs are a rare cause of trigeminal neuralgia. Treatment is challenging and harbors the risk of venous occlusion of the superior petrosal vein following transvenous Squid embolization.
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Abbreviations
- AV:
-
Arteriovenous
- CCA:
-
Common carotid artery
- DAVF:
-
Dural arteriovenous fistula
- DMSO:
-
Dimethyl sulfoxide
- DSA:
-
Digital subtraction angiography
- DWI:
-
Diffusion-weighted imaging
- ECA:
-
External carotid artery
- FLAIR:
-
Fluid-attenuated inversion recovery
- ICA:
-
Internal carotid artery
- MMA:
-
Middle meningeal artery
- MRI:
-
Magnetic resonance imaging
- n-BCA:
-
n-butyl cyanoacrylate
- NECT:
-
Nonenhanced computed tomography
- SPS:
-
Superior petrosal sinus
- SPV:
-
Superior petrosal vein
- VA:
-
Vertebral artery
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Dorn, F. (2022). Dural Arteriovenous Fistula of the Superior Petrosal Sinus: Postinterventional SAH and Edema of the Brainstem and Cerebellum due to Thrombosis of the Superior Petrosal Vein. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Arteriovenous Malformations and Fistulas Casebook. Springer, Cham. https://doi.org/10.1007/978-3-030-51200-2_34-1
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