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 fistulae[1],[2],[3].
