• Satoru Tanioka, Yu Sato, Mai Nampei, Kazuhiko Tsuda, Shigehiko Niwa, and Hidenori Suzuki.
• Department of Neurosurgery, Matsusaka Central General Hospital, Matsusaka, Japan. Electronic address: satoru-tanioka@umin.net.
• World Neurosurg. 2016 Nov 1; 95: 617.e7-617.e12.

BackgroundCavernous sinus (CS) dural arteriovenous fistula (DAVF) rarely causes intracranial hemorrhage. The authors describe a case of CS DAVF presenting with intracranial hemorrhage, focusing on the findings in digital subtraction angiography (DSA) performed before and after the onset.Case DescriptionAn 80-year-old woman, diagnosed as Borden type 3 CS DAVF on DSA 2 years before, presented with subarachnoid hemorrhage and right temporal subcortical hemorrhage. DSA findings after the onset showed that the right superficial middle cerebral vein, the sole drainage of the DAVF, had various changes including stenosis on the proximal portion, venous pouch formation, and occlusion of the distal portion compared with those 2 years before the onset. The occlusion was observed near the point where drainage of DAVF joined normal brain venous drainage, suggesting that the competition between the drainages caused impaired venous drainage, stagnation, and subsequent thrombotic occlusion. The CS DAVF was treated with evacuation of the intracerebral hematoma and surgical interruption of the right superficial middle cerebral vein at the dural origin from the CS.ConclusionsThis report showed the development of thrombotic occlusion of a distal draining cortical vein as one of risk factors for CS DAVFs to cause intracranial hemorrhage on repeated DSAs.Copyright © 2016 Elsevier Inc. All rights reserved.

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