Rossmann Tobias, Veldeman Michael, Nurminen Ville, Raj Rahul, Niemelä Mika
1Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Finland.
2Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria; and.
J Neurosurg Case Lessons. 2022 Nov 14;4(20). doi: 10.3171/CASE22365.
Dural arteriovenous fistulas (dAVF) may induce imaging findings attributable to various disease entities including malignant neoplasms. In these cases, diagnosis and adequate treatment are often delayed and patients may be exposed to spurious treatments in addition to the risks inherent to an untreated dAVF with cortical venous drainage.
The authors report a case of a patient referred for surgical treatment of a supratentorial high-grade glioma. Thorough review of imaging data challenged the initial radiological diagnosis and led to proper angiographic workup. As a result, a high-grade dAVF was confirmed and successfully embolized. In addition to this case, we provide an extensive literature review on dAVF initially diagnosed as cerebral neoplasms, including clinical, imaging and follow-up data.
The literature provides diagnostic criteria for dAVF on magnetic resonance imaging; however, those criteria may be only partly applicable in many cases. Misdiagnosis of a neoplasm due to dAVF has been reported but remains rare, especially in supratentorial lesions. Digital subtraction angiography should be pursued to rule out an underlying vascular pathology if any doubt. This may prevent unnecessary interventions such as biopsies, pharmacological treatment and a delay in dAVF treatment, given its associated risk of hemorrhage and nonhemorrhagic neurological deficits.
硬脑膜动静脉瘘（dAVF）可能导致可归因于包括恶性肿瘤在内的各种疾病实体的影像学表现。在这些情况下，诊断和适当治疗往往会延迟，并且除了未经治疗的伴有皮质静脉引流的dAVF所固有的风险外，患者还可能接受不必要的治疗。
作者报告了一例因幕上高级别胶质瘤接受手术治疗的患者。对影像数据的全面审查对最初的放射学诊断提出了质疑，并导致了适当的血管造影检查。结果，确诊为高级别dAVF并成功进行了栓塞。除了这个病例，我们还对最初被诊断为脑肿瘤的dAVF进行了广泛的文献综述，包括临床、影像和随访数据。
文献提供了磁共振成像上dAVF的诊断标准；然而这些标准在许多情况下可能仅部分适用。因dAVF导致的肿瘤误诊已有报道，但仍然罕见，尤其是在幕上病变中。如果有任何疑问，应进行数字减影血管造影以排除潜在的血管病变。鉴于其相关的出血风险和非出血性神经功能缺损，这可能会防止不必要的干预，如活检、药物治疗以及dAVF治疗的延迟。
