De Novo dural arteriovenous fistulas after endovascular treatment: Case illustration and literature review

Abstract

Intracranial dural arteriovenous fistulas (dAVF) account for nearly 10–15% of all arteriovenous malformations. Although the majority of dAVF are effectively cured after endovascular intervention, there are cases of dAVFs that may recur after radiographic cure. We present the case of a 69-year-old female with de novo formation of three dAVFs in different anatomic locations after successive endovascular treatments. The patient's initial dAVF was identified in the right posterior frontal convexity region and obliterated with transarterial and transvenous embolization. The patient returned eight years later due to left-sided pulsatile tinnitus and a new dAVF in the left greater sphenoid wing region was seen on angiography. This was treated with transvenous embolization with complete resolution. One year later, she developed left sided pulsatile tinnitus again and was found to have a left carotid-cavernous dAVF. This is the first case report to our knowledge of the formation of three de novo dAVFs over multiple years in distinct anatomical locations. We also review the literature regarding de novo dAVFs after endovascular treatment which includes 16 cases. De novo dAVF formation is likely due to numerous factors including changes in venous flow and aberrant vascular development. It is important to further understand the relationship between endovascular treatment and recurrent dAVF formation to prevent subsequent malformations.

New insight into DAVF pathology—Clues from meningeal immunity

“…However, there are still some lesions that cannot be obliterated due to anatomical reasons and material limitations. Meanwhile, the occurrence of de novo DAVF after treatment is also common (143)(144)(145). Furthermore, in addition to the elimination of lesions on imaging, the long-term prognosis of patients is also worthy of our attention.…”