Simultaneous unilateral moyamoya disease and ipsilateral dural arteriovenous fistula: case report.

Document Type

Article

Abstract

OBJECTIVE: Previous reports have described an association between moyamoya disease and arteriovenous malformations, but this unusual case is the first report of a unilateral moyamoya pattern simultaneously associated with an ipsilateral dural arteriovenous fistula (dAVF).

CLINICAL PRESENTATION: A 44-year-old man presented with headache, tinnitus, and an intraventricular hemorrhage, as seen on computed tomographic scans. Cerebral angiography showed a right moyamoya pattern and an ipsilateral dAVF fed by branches of the external carotid artery and draining into the transverse sinus.

INTERVENTION: After the intraventricular hemorrhage resolved, the patient underwent transarterial embolization of the dAVF with Onyx (EV3, Inc. Irvine, CA), followed by a direct superficial temporal artery-to-middle cerebral artery bypass. Subsequent reconstitution of the dAVF required transvenous embolization, which obliterated the dAVF. At his 2-month follow-up examination, the patient was asymptomatic and neurologically intact.

CONCLUSION: Recent investigations have established that both moyamoya disease and dAVFs are associated with dural angiogenesis. These factors may represent a mechanism for vaso-occlusive ischemia contributing to the formation of dAVF. This extremely rare coincidental presentation may have deeper pathogenic implications.

Medical Subject Headings

Adult; Central Nervous System Vascular Malformations; Humans; Male; Moyamoya Disease

Publication Date

6-1-2008

Publication Title

Neurosurgery

ISSN

1524-4040

Volume

62

Issue

6

First Page

1375

Last Page

1376

PubMed ID

18824958

Digital Object Identifier (DOI)

10.1227/01.neu.0000333311.87554.9c

This document is currently not available here.

Share

COinS