Dural AVF with Venous Aneurysm Causing Mass Effect: Management Strategy
A 58-year-old male presented with progressively increasing headaches. CT scan revealed ventricular dilation (lateral and third ventricles) along with periventricular ooze. A hyperdense lesion was seen compressing upon dorsal midbrain (Fig. 63.1a, b). MRI brain revealed a large dilated vascular structure compressing upon the dorsal midbrain along with adjacent dilated vessels (Fig. 63.1c, d). It was causing compression of aqueduct with resultant hydrocephalus. DSA revealed a dural arteriovenous fistula fed by bilateral middle meningeal arteries (Fig. 63.1e, f). Aneurysmal dilation was seen in the draining vein. Trans-arterial onyx embolization was planned.