Case summaries: pathologic findings, treatments, and results

Case No./ Patient Sex, AgePathologic FindingsTreatmentResult
1/M, 10 moMacrocephalus. No cardiac failure. Vein of Galen malformation diagnosed in utero.Two sessions of arterial and venous embolization with coils and glue. Trispan device deployed at the outlet of the venous pouch to prevent coil migration.No complication related to treatment. Fistula almost closed. Normal development (at 6-mo follow-up). Cranial overgrowth reduced. Control angiography with embolization if necessary was scheduled.
2/F, 84 ySubarachnoid hemorrhage. Right transverse sinus dural fistula with reflux in the superior sagittal sinus and cerebral venous congestion. Benign left sigmoid dural fistula without reflux.Transvenous occlusion of the right transverse sinus with coils. Trispan deployed just distal to the confluence of a right ambivalent vein of Labbé to avoid coil migration and occlusion of the outlet of the vein of Labbé.No treatment related complication. Cure of the right transverse fistula. Marked improvement of the cerebral venous drainage and congestion. Left fistula unchanged.
3/F, 47 ySubarachnoid hemorrhage. Complex dural fistula of the vein of Galen region with deep cerebral venous reflux.Arterial embolization via meningeal branches with coils and glue to reduce the shunt. Transvenous occlusion of a deep cerebral venous pouch draining the fistula. Two Trispan devices used to prevent coil migration outside the pouch to the straight sinus.No complication related to treatment. Good recovery. Fistula dramatically reduced and transformed into a benign type (no cerebral venous reflux) at 3-mo follow-up angiography.
4/F, 10 yMultiple, very high-flow complex and evolving dural fistulas of the left transverse, torcular, and right sigmoid sinuses. Left jugular vein occluded. Right jugular vein stenotic at the foramen. Increasing headaches. Four endovascular treatments. Intraventricular hemorrhage without sequela 2 wk prior to latest treatment.Surgical exposure and direct puncture of the right transverse sinus. Occlusion of the straight sinus and superior sagittal sinus with balloons to disconnect fistula from cerebral venous drainage. Trispan device deployed via right jugular vein to prevent coil migration. Coils and glue in the left transverse sinus and torcular.No technical complication. Left transverse fistula cured. Torcular fistula dramatically reduced. Right sigmoid sinus fistula unchanged. Cerebellar ataxia and dysphagia after embolization unexplained (MR imaging findings unchanged). Complete recovery within 10 d.