Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2024; 12(29): 6314-6319
Published online Oct 16, 2024. doi: 10.12998/wjcc.v12.i29.6314
Ruptured venous aneurysm associated with a dural arteriovenous fistula: Two case reports
You Sub Kim, Woong Yoon, Byung Hyun Baek, Seul Kee Kim, Sung Pil Joo, Tae Sun Kim
You Sub Kim, Sung Pil Joo, Tae Sun Kim, Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju 61469, South Korea
Woong Yoon, Byung Hyun Baek, Department of Radiology, Chonnam National University Hospital and Medical School, Gwangju 61469, South Korea
Seul Kee Kim, Department of Radiology, Chonnam National University Hwasun Hospital, Hwasungun 58128, South Korea
Author contributions: Kim YS was responsible for writing; Yoon W was responsible for conceptualization and study design; Kim YS, Joo SP, and Kim TS were responsible for data curation; Baek BH and Kim SK were responsible for radiologic findings; all authors have read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict-of-interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Woong Yoon, MD, PhD, Professor, Department of Radiology, Chonnam National University Hospital and Medical School, 42 Jebong-ro, Donggu, Gwangju 61469, South Korea. radyoon@jnu.ac.kr
Received: May 4, 2024
Revised: July 27, 2024
Accepted: August 8, 2024
Published online: October 16, 2024
Processing time: 116 Days and 6.2 Hours
Abstract
BACKGROUND

In general, venous aneurysm associated with dural arteriovenous fistula (dAVF) is considered to be developed under long standing venous hypertension and manifested as venous ectasia of draining vein itself. However, discrete saccular shaped venous aneurysm without angiographic evidence of venous hypertension arising from the draining vein, like cerebral arterial aneurysm, is quite rare and its pathomechanism remains unclear in patients with dAVF.

CASE SUMMARY

In this report, we present two cases of ruptured saccular venous aneurysms associated with dAVF without venous hypertension or venous ectasia. In both cases, significant curve or stenosis is observed in draining vein, which is located in just distal portion of the venous aneurysms. These aneurysms were successfully treated with a transarterial embolization. Underlying mechanism of venous aneurysms in these cases is discussed.

CONCLUSION

Although there is little doubt that hemodynamic stress has a critical role in the development of venous aneurysms in patients with dAVF, preceding venous hypertension or venous ectasia is not necessary for development and enlargement of venous aneurysms. Considering the significant risk of rupture, a careful review of draining vein features including tortuosity or stenosis is needed, especially in venous aneurysms without evidence of venous hypertension.

Keywords: Dural arteriovenous fistula; Venous aneurysm; Hemodynamic stress; Intracranial hemorrhage; Embolization; Case report

Core Tip: Venous aneurysms associated with dural arteriovenous fistula (dAVF) have been generally considered to be developed in the setting of venous hypertension or venous ectasia. However, saccular venous aneurysm in patients with dAVF could develop without preceding venous ectasia or venous hypertension and this situation is very rare. So, its pathomechanism remains unclear in patients with dAVF. In this report, we present rare cases of venous aneurysms in the absence of venous hypertension, and describe underlying unique angiographic features; presence of curved or stenotic portion within long and tortuous draining vein.