Dural arteriovenous fistulas of the occipital sinus secondary to trauma: Two case reports and a review of the literature

Surgical Neurology International, 2025 · DOI: 10.25259/SNI_958_2024 · Published: January 10, 2025

Simple Explanation

Dural arteriovenous fistulas (DAVFs) are rare abnormalities in the brain where arteries and veins connect in the dura (the brain's outer covering). Normally, these vessels don't directly connect. The occipital sinus (OS) is a small vein in the back of the head. DAVFs in this area are very rare. These abnormal connections can cause problems because they change how blood flows in the brain. This paper presents two cases where trauma (head injury) may have led to the development of OS DAVFs. It discusses the challenges of diagnosing and treating these rare lesions, emphasizing the need for personalized treatment plans.

Study Duration

Not specified

Participants

Two case reports and a literature review of 8 cases

Evidence Level

Case reports and literature review

Key Findings

1
Trauma can be a significant factor in the development of OS DAVFs. Both cases presented involved patients with a history of head trauma prior to the development of the fistula.
2
Successful treatment of OS DAVFs often requires a combined approach, utilizing both transvenous embolization (TVE) and/or surgical intervention due to the complex arterial feeders and venous drainage patterns.
3
Early intervention is crucial in preventing irreversible neurological deficits. Prolonged venous congestion from the fistula can lead to significant disability, emphasizing the need for timely diagnosis and treatment.

Research Summary

This paper reports two cases of dural arteriovenous fistulas (DAVFs) of the occipital sinus (OS) that developed after head trauma. These rare vascular malformations pose diagnostic and therapeutic challenges. The cases highlight the importance of considering trauma as a potential factor in the development of OS DAVFs. They also underscore the need for individualized treatment strategies due to the complex nature of these lesions. Successful management often requires a combined approach, utilizing both endovascular techniques and surgical intervention to obliterate the abnormal arteriovenous shunting and prevent further neurological complications.

Practical Implications

Improved Diagnostic Awareness

Clinicians should consider OS DAVFs in patients presenting with neurological symptoms and a history of head trauma, even if remote.

Personalized Treatment Planning

Treatment strategies for OS DAVFs should be tailored to the individual patient's anatomy and clinical presentation, often requiring a combination of endovascular and surgical techniques.

Importance of Early Intervention

Early diagnosis and treatment of OS DAVFs are critical to prevent irreversible neurological deficits and improve patient outcomes.

Study Limitations

1
The study is limited by the small sample size of two case reports, which may not be representative of all OS DAVFs.
2
The exact mechanisms of injury leading to DAVF formation remain uncertain due to the extended time interval since the trauma and the lack of detailed records.
3
The lack of genetic and developmental data limits the ability to fully explore the roles of congenital factors in OS DAVF pathogenesis.

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