13.8
DAVFs in Pediatric Patients
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a
b
c
d
Fig. 13.20 Dural arteriovenous fistula at the level of the SSS in a child. Angiogram (a) of the right external carotid artery (lateral view). Dilated branches of the middle meningeal artery (MMA) (arrow), supplying the fistula in the middle portion of the enlarged SSS. A meningeal supply also came from the left MMA. Early (b) and late (c) venous phase. The SSS is distally occluded at the level of the torcular herophili (arrow). There is a venous congestion, with rerouting of the venous drainage partially in the straight sinus (SS) and further in the internal cerebral vein (arrow), especially in the basal vein (BV) bilaterally,
continuing to its anterior tributaries. The superficial venous system drains mainly into the cavernous sinus (CS) and further to the inferior petrosal sinus (IPS), jugular vein, and superior ophthalmic vein (SOV). There is also a retrograde injection of the dilated cerebellar vein. Right external carotid angiogram, AP view (d) showing that the connection to the SSS occurs through a large venous pouch (arrow), to which converge several branches of the MMA. In the late phase (e), the duplicated SSS, dilated on the left, is visible. Both TSs are proximally occluded (arrows). Retrograde injection of the basal veins (BV)