PMC10408637_01
A 54-year-old woman with a dural arteriovenous fistula (DAVF) involving the superior sagittal sinus (SSS). (a) Right external carotid artery (ECA) angiogram, arterial phase, demonstrating a long segment DAVF (Borden II - Cognard IIa+b) involving the middle to posterior thirds of the SSS with supply from the right superficial temporal artery and right middle meningeal artery (MMA) into the middle third of the SSS (star). (b) Right ECA angiogram, late arterial phase, demonstrating reflux into cortical veins (CVs) and occlusion of the SSS. (c) Left common carotid injection, arterial phase, demonstrating a fistulous connection between the left MMA and the middle third of the SSS. (d) Left common carotid injection, venous phase, revealing reflux into CVs and the left vein of Trolard. Labbe: Inferior anastomotic vein of Labbe, MMA: Middle meningeal artery, OA: Occipital artery, STA: Superficial temporal artery.
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F1
A cerebral angiogram was then performed which revealed a DAVF (Borden II - Cognard IIa+b) involving the middle to posterior thirds of the SSS supplied by multiple arterial sources [Figure 1].
Angiogram performed 1 year later. Right external carotid artery (ECA) angiogram, lateral (a) and anterior-posterior (b) views, demonstrating patent filling of the right ECA and its branches. No evidence of early venous drainage to suggest dural arteriovenous fistula (DAVF). (c) Common carotid injection, arterial phase, revealing normal filling and no evidence of fistula. (d) Left internal carotid injection, venous phase, demonstrating no evidence of DAVF. Superior sagittal sinus thrombosis and venous engorgement of cortical veins (star) are observed.
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F2
The SSS remained occluded, and drainage was noted through extensive dilatated cortical veins as collaterals [Figure 2].