Dural arteriovenous fistula of the torcular herophili presenting with hydrocephalus and venous congestion in an 8-month-old child: A case report

Dimitri T K. Ndandja; Gerald Musa; Rossi E C. Barrientos; Matvey I Livshitz; Suzy N J. Manko; Gennady E Chmutin; Hovrin V Dmitri; Bupe M Mwela; Slabov V Mihail

doi:10.4103/bc.bc_71_22

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CASE REPORT

Year : 2023 | Volume : 9 | Issue : 1 | Page : 39-43

Dural arteriovenous fistula of the torcular herophili presenting with hydrocephalus and venous congestion in an 8-month-old child: A case report

Dimitri T K. Ndandja¹, Gerald Musa¹, Rossi E C. Barrientos¹, Matvey I Livshitz², Suzy N J. Manko³, Gennady E Chmutin⁴, Hovrin V Dmitri⁵, Bupe M Mwela⁶, Slabov V Mihail⁵
¹ Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
² Department of Neurosurgery, Morozov Children's City Clinical Hospital, Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents, Moscow, Russia
³ Department of Anatomy, Ryazan State Medical University I.P Pavlov, Moscow, Russia
⁴ Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN University); Department of Neurosurgery, Morozov Children's City Clinical Hospital, Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents, Moscow, Russia
⁵ Department of Neurosurgery, City Clinical Hospital Named after C.C Yudina, Moscow, Russia
⁶ Department of Pediatrics, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia

Correspondence Address:
Gerald Musa
Department of Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Potapovskaya Roscha 7k2, Moscow
Russia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/bc.bc_71_22

Dural arteriovenous fistulas (DAVFs) are direct communication between the dural arterial and venous systems. They are more common in adults. In children, they are relatively rare. Hydrocephalus is a common problem in pediatrics with a variety of causes. However, very few cases of hydrocephalus as a complication of DAVF have been reported in the literature. This case describes an 8-month-old male child with a large DAVF at the torcular herophili who presented with regression of milestones and hydrocephalus. Magnetic resonance imaging (MRI) on admission showed triventricular hydrocephalus and a massively dilated torcular with a compressed fourth ventricle. Angiography confirmed the presence of a DAVF at the torcula with arterial feeders from the posterior circulation. Endovascular embolization was performed with >80% embolization of the fistula with no complications. Control MRI immediately postoperative was acceptable. No cerebrospinal fluid (CSF) diversion was performed. At a 3-month follow-up, the child had attained all developmental milestones for age. MRI showed normal CSF dynamics and a further reduction in the size of the torcula. Despite being rare, DAVFs should be considered as a possible cause of pediatric hydrocephalus, and treating them can lead to a resolution of the mechanisms inducing hydrocephalus. CSF shunting should be reserved for those cases with persistent hydrocephalus and raised intracranial pressure despite endovascular treatment.

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