Dural arteriovenous fistula after craniotomy for pilocytic astrocytoma in a patient with protein S deficiency

Section of Neurosurgery, Department of Surgery and Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
Surgical Neurology (Impact Factor: 1.67). 08/2002; 58(1):59-64; discussion 64. DOI: 10.1016/S0090-3019(02)00730-9
Source: PubMed


We report an unusual case, which may provide insight into the etiology and pathogenesis of dural arteriovenous malformation.
A 24-year-old woman presented with hemorrhage into a pilocytic astrocytoma of the collicular plate. Angiography was normal and the tumor was surgically resected. She developed sigmoid sinus thrombosis and a transverse/sigmoid sinus dural arteriovenous fistula 11 months after this and was found to have protein S deficiency. The fistula was not treated. Angiography 4 years later was unchanged.
This report illustrates an acquired etiology of a dural arteriovenous fistula. To our knowledge this is the first reported case of postoperative sigmoid sinus thrombosis along with arteriovenous fistula in a patient with previously undetected protein S deficiency.

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    • "Several studies have shown that dural AVF is associated with thrombosis of the involved sinus.9,10 One possible mechanism for the development of acquired dural AVF is that increased venous pressure after sinus thrombosis opens intrinsic channels between the cerebral arteries and venous sinuses.11 Another is that increased venous pressure may elicit local ischemia and increase ischemia-related angiogenesis.12 "
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