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Mixed pial-dural fistula development after ventricular shunting
  1. Yince Loh1,2,
  2. David Newell2
  1. 1Interventional Neuroradiology and Neurocritical Care Services, Madigan Army Medical Center, Tacoma, Washington, USA
  2. 2Cerebrovascular Center, Swedish Neuroscience Institute, Seattle, Washington, USA
  1. Correspondence to Dr Yince Loh, Interventional Neuroradiology and Neurocritical Care Services, Madigan Army Medical Center, Building 9040, Fitzsimmons Drive, Tacoma, WA 98431, USA; yincer{at}

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Case report

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.

Figure 1

Lateral projection angiography before and after resection of the mixed pial-dural arteriovenous fistula (p-dAVF). Digital subtraction (A) and unsubtracted (B) injection of the right internal carotid artery demonstrates …

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