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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.
Contributors Both authors were involved in the manuscript design, data collection, analysis, manuscript drafting and final proofing.
Competing interests The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense or the US Government.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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