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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282XOn-line version ISSN 1678-4227

Arq. Neuro-Psiquiatr. vol.75 no.9 São Paulo Sept. 2017

https://doi.org/10.1590/0004-282x20170117 

IMAGES IN NEUROLOGY

Dural sinus malformation presenting with seizure and treated by combined arterial and venous embolization

Malformação dos seios durais apresentando-se com crises convulsivas e tratada com embolização arterial e venosa combinada

Ulysses C. Batista1  2 

Thiago Giansante Abud1  2  3 

Carlos Eduardo Baccin1  2  3 

Renato Tavares Tosello1  2 

Aron Athayde Diniz1  2 

Benedito Jamilson Araújo Pereira1 

Ronie Leo Piske1  2  3 

1Hospital Beneficência Portuguesa de São Paulo, Centro de Neuroangiografia (CNA), São Paulo SP, Brasil;

2Hospital Alvorada, Neuroradiologia Intervencionista, São Paulo SP, Brasil;

3Hospital Albert Einstein, Neuroradiologia Intervencionista, São Paulo SP, Brasil.


A newborn with a prenatal diagnosis of dural sinus malformation, which was confirmed by an MRI (Figure 1). He was followed and at the first seizure (third month), a CT angiography was performed, which showed a partial thrombosis and an increase of the mass effects (Figure 2).

Figure 1 (A) Axial T2 weighted MRI of the brain showing the flow inside the dural venous malformation (black asterisk) and posteriorly of it, an area of partial thrombosis (white asterisk). A peripheral venous vascular malformation, commonly associated to the dural venous malformation, is indicated with the white arrow. (B) Coronal 3D MR angiogram after contrast injection showing the superior sagittal sinus malformation. 

Figure 2 Axial (A) and sagittal (B) contrast enhanced CT angiography showing the extension of thrombosis (white asterisks) and the mass effect in the posterior sagittal sinus malformation (black asterisks). Note the communication between the straight sinus and the posterior superior sagittal sinus and the vein of Galen (black arrow). The anterior superior sagittal (white arrow) and inferior sagital sinus (large white arrow) are preserved. 

We performed three endovascular procedures (one per week) combining arterial and venous embolization, without complications (Figures 3 and 4). The patient was discharged without deficits.

Figure 3 Lateral view of early (A) and late phase (B) occipital selective artery angiography showing a high flow dural arteriovenous fistula fed by meningeal branches from the occipital artery and feeding the superior sagittal sinus malformation (white asterisk). Note the dilated vein of Galen (black arrow) associated with deep venous hypertension and the superior sagittal sinus malformation (white asterisk). 

Figure 4 Lateral view final cast (A) of combining arterial and venous with liquid embolic and coil embolization filling the superior sagittal sinus malformation (white asterisk) and late phase of internal carotid digital angiography (B) after the endovascular embolization in the superior sagittal showing the lateral sinus (SL), the superior sagittal sinus (white arrows) and the internal cerebral vein (large white arrow) demonstrating that there was an improvement of the deep venous congestion. 

A dural sinus malformation is a serious condition that can evolve into seizures and hemorrhage. It is characterized by a giant dural sinus lake associated with slow flow arteriovenous fistulae1,2,3.

References

1. Lasjaunias P, Magufis G, Goulao A, Piske R, Suthipongchai S, Rodesch R et al. Anatomical aspects of dural arteriovenous shunts in children. Intervent Neuroradiol. 1996;2(3):179-91. [ Links ]

2. Benoit Jenny, et al. Giant dural venous sinus ectasia in neonates Report of 4 cases. J Neurosurg Pediatrics. 2010;5(5):523-8. [ Links ]

3. Rossi A, De Biasio P, Scarso E, Gandolfo C, Pavanello M, Morana G et al. Prenatal MR imaging of dural sinus malformation: a case report. Prenat Diagn. 2006;26(1):11-6. https://doi.org/10.1002/pd.1347Links ]

Received: October 19, 2015; Revised: August 29, 2016; Accepted: March 31, 2017

Correspondence: Ulysses C. Batista; Hospital Beneficência Portuguesa de São Paulo, Neuroradiologia Intervencionista; Rua Maestro Cardim, 769; 01323-900 São Paulo SP, Brasil; E-mail: ulyssescbatista@gmail.com

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License  This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.