• L Fernando Gonzalez, Nohra Chalouhi, Pascal Jabbour, Sonia Teufack, Felipe C Albuquerque, and Robert F Spetzler.
• Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: fernando.gonzalez@jefferson.edu.
• World Neurosurg. 2013 Dec 1;80(6):e359-65.

BackgroundCerebral venous thrombosis developing after surgical or endovascular obliteration of arteriovenous fistula (AVF) is a rare but devastating complication that has not been adequately reported.Case DescriptionTwo patients presenting with AVF (1 pial, 1 dural) and large venous pouches were successfully treated by surgical and endovascular means and were neurologically intact postoperatively. Rapid neurologic deterioration was seen on postoperative day 5 in the first patient and postoperative day 2 in the second patient. Both patients had massive cerebral venous thromboses on brain imaging and surgical exploration. One patient died and the other was severely disabled.ConclusionRapid occlusion of a high-flow AVF resulting in significant venous stasis can precipitate thrombosis of the venous system distal to the fistulous point. In the presence of large venous pouches and significant venous stasis, strict therapeutic anticoagulation may be required to prevent cerebral venous thrombosis. Therapeutic anticoagulation, though feasible following endovascular treatment, may prove particularly challenging after open surgical interventions given the risk of hemorrhagic complications.Copyright © 2013 Elsevier Inc. All rights reserved.

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