Superior sagittal sinus dural arteriovenous fistula with changes in angiographic findings associated with contiguous parasagittal meningioma: A case report

Abstract

Background: Meningioma and dural arteriovenous fistula (dAVF) located at the same site are rare. The present case demonstrated the transformation of tumor feeding vessels into the pial feeder of the dAVF over time, which may help to elucidate the pathogenesis of tumor-associated dAVF.

Case description: A 71-year-old man presented with convulsion. Magnetic resonance (MR) imaging showed a right parasagittal sinus meningioma invading the superior sagittal sinus (SSS). Bilateral external carotid angiography showed dAVF at the SSS, near the site of tumor invasion. The right internal carotid angiography showed tumor staining from the anterior cerebral artery with intra-tumor arteriovenous shunting, with stagnation of tumor blood flow, suggesting impairment of perfusion to the SSS. Four years after the initial diagnosis, the patient was admitted to hospital with status epilepticus, and MR imaging showed an enlarged tumor. Carotid angiography revealed transformation of the tumor feeders to the pial feeder of the dAVF. The findings of shunting to the SSS had intensified, and stenosis had occurred in the posterior third of the SSS. The venous return showed retrograde flow anteriorly to the SSS. The patient underwent endovascular embolization and tumor resection. The shunt had disappeared.

Conclusion: This report supports the proposal that impaired venous return is an important factor in the shunt occurrence of dAVF. Neurosurgeons should consider that cases of meningioma invading the venous sinuses may be complicated by dAVF and changes may occur over time.

Keywords: Dural arteriovenous fistula; Meningioma; Venous pressure.

Figure 1:

Parasagittal meningioma. Axial (a) and coronal (b) T1-weighted magnetic resonance images showing an enhanced tumor in the right parasagittal region that extends toward the superior sagittal sinus (SSS) (white arrow). (c) Lateral right internal carotid angiogram, arterial phase, showing a tumor blush supplied by the anterior cerebral artery (ACA). (d) Lateral right internal carotid angiogram, capillary phase, showing stasis of tumor blood flow. (e) Lateral right external carotid angiogram showing that both the middle meningeal artery (MMA) and superficial temporal artery (STA) supply the dural arteriovenous fistula (dAVF). (f) Lateral left external carotid angiogram showing that both the MMA and STA supply the dAVF.

Figure 2:

(a) Computed tomography scan showing left frontal subcortical hemorrhage. Axial (b) and coronal (c) T1-weighted magnetic resonance images showing a homogeneous enhanced growing tumor in the right parasagittal region that extends toward the superior sagittal sinus (SSS) (white arrow). (d) Lateral right internal carotid angiogram, arterial phase, showing a pial AVF fed by the ACA (white dotted arrow). (e) Lateral right internal carotid angiogram, capillary phase, showing retrograde blood flow anteriorly in the SSS (white arrowhead). (f) Anteroposterior right internal carotid angiogram showing cortical venous reflux in the left frontal cortex (white asterisk). Lateral right (g) and left (h) external carotid angiograms showing that the MMA, STA, and occipital artery supply the dAVF and stenosis of the posterior third of the SSS (white arrowhead).

Figure 3:

Tumor removal through right frontal craniotomy. The PIFA (white arrow) of the ACA was incised into the tumor (white asterisk) and a shunt vessel (white dotted arrow) was found on the anterior surface of the tumor.

Figure 4:

Postoperative axial (a) and coronal (b) T1-weighted magnetic resonance images confirming gross total resection of the tumor except for the superior sagittal sinus (SSS) invasion (white arrow). (c) Postoperative lateral right internal carotid angiogram, arterial phase, demonstrating disappearance of a pial AVF fed by the ACA. (d) Lateral right internal carotid angiogram, venous phase, showing antegrade flow of the SSS. Lateral right (e) and left (f) external carotid angiograms demonstrating disappearance of the dAVF.