Cerebral arteriovenous fistulas induced by dural arteriovenous shunts

Abstract

Dural arteriovenous shunts and pial arteriovenous fistulas are uncommonly associated. Their etiology, pathogenesis, and natural history are still unclear and are likely different. We present three cases of high-flow dural arteriovenous shunts associated with pial arteriovenous fistulas and discuss their pathogenesis, anatomic association, and angioarchitecture. We propose that venous steal effect in the dural sinus secondary to the high-flow dural arteriovenous shunt induced the pial arteriovenous fistulas. Treatment of the high-flow dural arteriovenous shunts and the induced pial arteriovenous fistulas are discussed.

Fig 1.

Right external carotid angiogram of case 3 shows the DAVSs at the superior sagittal sinus.

Fig 2.

Frontal-view right internal carotid angiogram of case 1 shows pial AVFs (horizontal arrows) and cortical venous reflux (oblique arrow).

Fig 3.

Selective injection of the left anterior cerebral branch of case 1 shows detailed angioarchitecture of the induced pial AVF. Reflux into the cortical vein in the right side is indicated (arrow).

Fig 4.

Left internal carotid angiogram of case two shows induced pial AVFs draining to the superior sagittal sinus (large arrow). A flow-related aneurysm has formed (vertical arrow). Reflux into cortical vein is noted (small arrow).