• Hiroaki Nagashima, Atsushi Fujita, Jun Tanaka, Masaaki Kohta, Takashi Sasayama, Kazuhiro Tanaka, Kohkichi Hosoda, and Eiji Kohmura.
• Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: hn0628hn@med.kobe-u.ac.jp.
• World Neurosurg. 2017 Aug 1; 104: 1050.e7-1050.e11.

BackgroundMagnetic resonance spectroscopy (MRS) is a potentially useful modality for evaluating brain metabolites in patients with dural arteriovenous fistula (dAVF). Here we describe a different pattern of MRS-based cerebral metabolism findings in patients with dAVF.Case DescriptionsWe performed MRS in 3 patients with transverse sigmoid sinus dAVF associated with cortical venous reflux. In case 1, which was associated with vasogenic edema on T2-weighted magnetic resonance imaging (MRI), decreased preoperative N-acetylaspartate (NAA)/creatine (Cr) and myo-inositol (mIns)/Cr and increased lactate (Lac)/Cr ratios improved after treatment. In case 2, a decreased preoperative NAA/Cr ratio improved after treatment. These 2 patients presented with seizures. In case 3, the patient presented with headache and showed no metabolic changes on preoperative or postoperative MRS.ConclusionsOur results suggest that patients with dAVF can be classified based on a combination of metabolic and signal changes seen on T2-weighted MRI. MRS may allow significantly expanded evaluation of the metabolic changes associated with dAVF for appropriate classification and management.Copyright © 2017 Elsevier Inc. All rights reserved.

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