Obstructive hydrocephalus associated with spontaneous dural arteriovenous fistula: A case report

RATIONALE: Dural arteriovenous fistulae (DAVF) are vascular disorders depicted with direct interconnection between dural arteries and cerebral venous sinuses and/or cortical veins. Only a hand full of cases have been reported in literature. DAVF obstructing the 3rd ventricle and quadrigeminal cistern resulting in hydrocephalus is very rare. PATIENT CONCERNS: We present a 55-year-old female with 2 years history of headaches and blurring of vision. Cranial nerves examinations were unremarkable. DIAGNOSES: Magnetic Resonance Imaging (MRI) and digital subtraction angiography showed multiple tortuous vascular malformation in the 3rd ventricle and quadrigeminal cistern resulting in obstructive hydrocephalus (OHC). INTERVENTIONS: We utilized endovascular embolization treatment option to obliterate the lesion. We used Onyx embolization agent (ev3 Neurovascular, Irvine, CA) to embolize the lesion via the transarterial route. OUTCOMES: The OHC resolved spontaneously after the endovascular embolization of the DAVF. The patient recovered with no further neurologic complication. Two years follow-up reveal no recurrence of the DAVF as well as hydrocephalus. LESSONS: Adequate knowledge on the vascular anatomy is very crucial in managing DAVF.