Department of Radiology, Dalhousie University Faculty of Medicine, Halifax, Canada.
Division of Neurosurgery, Dalhousie University Faculty of Medicine, Halifax, Canada.
BMJ Case Rep. 2024 Nov 28;17(11):e260637. doi: 10.1136/bcr-2024-260637.
A woman in her mid-50s who had undergone a subtotal resection of a peritorcular meningioma 3 years earlier presented with symptoms suggestive of increased intracranial pressure. A delayed diagnosis of a torcular dural arteriovenous fistula (dAVF) diagnosis was made on MRI. Digital subtraction angiography confirmed a torcular dAVF (Borden type II). Staged 3 rounds of transarterial (TA) embolisation were performed using n-butyl cyanoacrylate, ethylene vinyl alcohol copolymer and coils of the complex torcular dAVF, which significantly reduced the flow and corresponded with improved symptoms of pulsatile tinnitus, vision and headache. We reviewed previously reported cases of dAVFs that developed after craniotomy for meningioma resection. Despite its rarity, a torcular dAVF can develop after craniotomy and progress from low to high grade due to its location. Diagnosis requires a thorough understanding of subtle imaging findings, which may be present in follow-up studies obtained for tumour surveillance.
一位 50 多岁的女性，3 年前曾接受过颅旁脑膜瘤次全切除术，现出现颅内压增高的症状。MRI 检查提示迟发性硬脑膜动静脉瘘（dAVF）的诊断。数字减影血管造影证实为硬脑膜动静脉瘘（Borden Ⅱ型）。采用 n-丁基氰基丙烯酸酯、乙烯-乙烯醇共聚物和线圈对复杂的硬脑膜动静脉瘘进行了 3 轮分期经动脉（TA）栓塞治疗，显著减少了血流量，并对应改善了搏动性耳鸣、视力和头痛等症状。我们回顾了先前报道的脑膜瘤切除术后发生 dAVF 的病例。尽管罕见，但硬脑膜动静脉瘘可能在颅后窝手术后发生，并因位置关系从低级别进展为高级别。诊断需要对随访研究中可能存在的微妙影像学表现有透彻的了解，这些研究是为了监测肿瘤而进行的。
