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A 36-year-old male was first diagnosed with increased intracranial pressure following persistent headaches 3 years prior to presentation to our centre. A lumbar puncture had revealed elevated opening pressure, and he underwent ventriculo-peritoneal shunting for pseudotumor cerebri.
He presented to our centre due to decreased vision. An MRI was suspicious for a superior sagittal sinus (SSS) dural arteriovenous fistula (dAVF), and confirmed by MRA. He underwent catheter angiography, confirming the dAVF but also a separate mixed pial-dural arteriovenous fistula (p-dAVF) at the catheter (figure 1), which used the diseased SSS segment for outflow. Since transvenous occlusion of this segment was a planned part of his endovascular therapy, the p-dAVF was surgically disconnected first, to avoid p-dAVF outflow occlusion.
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