A Case of an Intraosseous Arteriovenous Fistula at the Squamous Part of the Occipital Bone with Spontaneous Occlusion of Diploic Venous Drainage

Overview

Journal J Neuroendovasc Ther

Specialty Neurology

Date 2024 Sep 23

PMID 39309173

Authors

Naoki Irizato

Katsunori Asai

Hiroto Okubata

Akihiro Tateishi

Masaaki Taniguchi

Akatsuki Wakayama

Affiliations

Soon will be listed here.

Abstract

Objective: An intraosseous arteriovenous fistula (AVF) is a rare fistula with an intracranial shunted pouch. A case of an intraosseous AVF at the squamous part of the occipital bone with spontaneous occlusion of diploic venous drainage is described.

Case Presentation: The patient, a Japanese woman in her 80s, presented with headaches at the back of the head and a history of multiple unruptured cerebral aneurysms but no recent head trauma. MRA showed abnormal signals in the occipital diploic region, and DSA showed an intraosseous AVF with a shunted pouch in the squamous part of the occipital bone near the inion. This was not seen on MRA 6 months earlier. One month later, follow-up examinations showed spontaneous occlusion of the diploic venous drainage, leading to a change in retrograde drainage into the superior sagittal sinus. Transvenous coil embolization was performed, and the shunted pouch was completely occluded. Postoperatively, the patient's symptoms resolved, and subsequent follow-ups showed no recurrence of the AVF.

Conclusion: This case suggested that the vascular architecture of intraosseous AVFs might change over a short period. Transvenous embolization was effective in obliterating the intraosseous shunted pouch.

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