Hydrocephalus with Ventricular Papillary Structure Induced by Aggressive Intracranial Dural Arteriovenous Fistulas

Hung-Yu Wen; Shun-Tai Yang; Yang-Lan Lo

doi:10.1016/j.wneu.2019.08.214

Hydrocephalus with Ventricular Papillary Structure Induced by Aggressive Intracranial Dural Arteriovenous Fistulas

World Neurosurg. 2019 Dec:132:208-210. doi: 10.1016/j.wneu.2019.08.214. Epub 2019 Sep 7.

Authors

Hung-Yu Wen¹, Shun-Tai Yang², Yang-Lan Lo³

Affiliations

¹ Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (R.O.C.); Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan (R.O.C.); Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan (R.O.C.).
² Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (R.O.C.); Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan (R.O.C.); Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (R.O.C.). Electronic address: yst0708@gmail.com.
³ Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (R.O.C.); Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan (R.O.C.).

PMID: 31505278
DOI: 10.1016/j.wneu.2019.08.214

Abstract

A 76-year-old man presented with progressive dementia, gait disturbance, and urinary incontinence for 1 year. Computed tomography scan revealed nonobstructive hydrocephalus, but abnormal papillary structures at the ventricular wall were noted. Before cerebrospinal fluid (CSF) diversion surgery for hydrocephalus, we performed magnetic resonance angiography and magnetic resonance venography, which revealed multiple engorged vessels over the ventricular wall and bilateral hemispheres. Digital subtraction angiography revealed 2 dural arteriovenous fistulas (DAVFs) at the left transverse-sigmoid sinus and superior sagittal sinus. Signs of angioarchitecture characteristic of cerebral venous hypertension (CVH) were noted, including cortical vein regurgitation and severe pseudophlebitic pattern. DAVFs with CVH might be a factor contributing to acquired hydrocephalus. DAVFs should be considered when patients with hydrocephalus exhibit abnormal papillary structures at the ventricular wall. Performing CSF diversion surgery for hydrocephalus before downgrading or curing such aggressive DAVFs may lead to major complications.

Keywords: Dural arteriovenous fistula; Hydrocephalus; Papillary structure; Venous hypertension.

Publication types

Case Reports

MeSH terms

Aged
Angiography, Digital Subtraction
Central Nervous System Vascular Malformations / complications*
Central Nervous System Vascular Malformations / pathology
Central Nervous System Vascular Malformations / surgery
Cerebral Ventricles / pathology*
Cerebral Ventricles / surgery
Humans
Hydrocephalus / etiology*
Hydrocephalus / pathology
Hydrocephalus / surgery
Hypertension / etiology
Magnetic Resonance Imaging
Male
Neurosurgical Procedures / methods
Tomography, X-Ray Computed
Treatment Outcome