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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1809558
Case Report

De novo Dural Arteriovenous Fistula at the Drainer Site after Embolization of Brain Arteriovenous Malformation

Tetsuya Ioku
1   Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan
,
Shigeru Miyachi
1   Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan
,
Naoki Matsuo
1   Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan
,
Reo Kawaguchi
1   Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan
,
Fuminori Ato
1   Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan
,
Tadashi Watanabe
1   Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan
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Abstract

We report a rare case of de novo ectopic dural arteriovenous fistula (dAVF) that developed late after the endovascular embolization of a brain arteriovenous malformation (AVM). A 25-year-old man with severe chronic headache was diagnosed with an unruptured right frontal AVM located on the medial side of the Sylvian fissure. The AVM was completely occluded using transarterial liquid embolization. However, 12 months after the embolization, the patient developed right pulsatile tinnitus. Angiography revealed a de novo dAVF at the convexity, distant from the original AVM nidus. The dAVF was supplied by multiple dural arteries and a small pial contribution and drained into a cortical vein previously used as the AVM's drainage route. The fistula was successfully treated with additional embolization and radiosurgery. It is well known that large, superficial AVMs tend to involve meningeal arterial supply. However, this case demonstrated delayed ectopic dAVF formation along a draining vein far from the nidus. Although the exact etiology remains unclear, drastic hemodynamic changes in cortical veins previously used as shunt draining route may induce unexpected angiogenesis, leading to the formation of such an unusual de novo dAVF. Even after successful AVM occlusion, long-term follow-up imaging is important, and the possibility of dAVF formation would offer stronger clinical guidance.

Keywords

angiogenesis - brain arteriovenous malformation - de novo dAVF - dural arteriovenous fistula - embolization

Authors' Contributions

N.M., R.K., and F.A. treated the patient, designed and conceptualized the study, and analyzed the data, T.I. drafted the manuscript for intellectual content, S.M. revised the manuscript, and T.W. read and approved the final version.


Ethical Approval

This study waived approval of the Institutional Review Board (IRB), and IRB approval for case reports is not required at our institution. We obtained individual written informed consents for the procedure and publication.


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Publication History

Article published online:
10 June 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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