2023 Volume 32 Issue 2 Pages 112-117
An 82-year-old man was transferred to the emergency department for evaluation of headache and disturbance of consciousness. Computed tomography revealed cerebral hemorrhage in the right occipital lobe and a right acute subdural hematoma. Digital subtraction angiography showed a non-sinus type dural arteriovenous fistula (AVF) in the vicinity of the transverse sinus, which formed a varix in the cortical vein and drained into the superior sagittal sinus. Blood flow was also observed from the right posterior cerebral artery (PCA) into the same cortical vein via a pial AVF. We performed direct surgery for shunt disconnection. Cortical venous drainage of the dural AVF was disconnected in the vicinity of the dura mater. A PCA branch was connected to the same cortical vein, and this shunt point was disconnected. Direct surgery is preferred in patients in whom dural and pial AVFs are observed with shunt points located both on the dura mater and on the brain (as in the present case) because the exact location of the shunt point can be confirmed under direct vision, which facilitates safe and accurate intervention.
