Giant dural arteriovenous fistula in a pediatric patient: positive outcome following surgical treatment

Abstract

Purpose: Our purpose is to present an atypical case of a 4-month-old patient with a giant dural arteriovenous fistula (DAVF).

Methods: Presentation of a case report and review of the literature.

Results: The DAVF arterial supply was through the middle meningeal artery bilaterally and the anterior and middle cerebral arteries on the right hemisphere. The venous drainage was through the posterior two-thirds of the superior sagittal sinus. The endovascular team performed an embolization to reduce the flow of the lesion, and finally, the surgical team completed the excision of the residual venous sac, without causing any significant neurological deficit. We used a double surgical approach done with two surgical teams in order to optimize the hemostasis control and reduce morbidity and mortality.

Conclusion: Midline DAVF usually has devastating consequences in children. Endovascular treatment is the first choice since it has lower mortality. Nevertheless, it requires multiple interventions, and the cure of the disease may not be achieved. We believe that joint endovascular and surgical treatment, supported by a reliable multidisciplinary medical team, is a good option for this type of lesions.

Keywords: Dural arteriovenous fistula; Endovascular; Pediatrics; Surgery; Vascular malformation.