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  • Imaging Casebook
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Imaging Case Book

Congenital dural arteriovenous fistula at torcula Herophili

Journal of Perinatology volume 27, pages 730–731 (2007)Cite this article

MR imaging and both MR and conventional angiography and venography demonstrated a high flow arteriovenous fistula supplied by bilateral middle meningeal arteries, causing massive enlargement of the inferior superior sagittal sinus and torcula Herophili. This enlargement of the torcula Herophili was the large vascular space appreciated on the initial sonogram. The draining transverse, sigmoid sinuses and jugular veins were enlarged bilaterally. The bilateral middle meningeal arteries were embolized at the time of the arteriogram with coils and glue, reducing the flow through the fistula by 90%.

Congenital dural arteriovenous fistulae (DAVF) are rare, much rarer than the already uncommon vein of Galen aneurysm.1 DAVF are more common in adults, in whom they are usually acquired lesions associated with thrombosis or obstruction of large venous sinuses.2 Congenital DAVF are attributed to abnormal development of the cranial dural venous sinuses.1 Lasjaunias1 has classified DAVF into three types: (a) dural sinus malformations with AV shunting, (b) infantile DAVF with large patent dural sinuses with no venous lakes, (c) adult type at the cavernous sinus. The DAVF with dural sinus malformation and venous lake is most commonly located at the torcula Herophili. These are often quite large lesions, but they are initially not associated with hydrocephalus, similar to what occurred in the patient presented here.1 Dilatation of the sigmoid sinuses and jugular veins is frequent. The lesions are usually supplied by bilateral middle meningeal artery feeders. Additional feeders may come from the occipital arteries, anterior inferior and posterior cerebellar arteries.1

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References

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  1. St Louis Children's Hospital Department of Radiology, Mallinckrodt Institute of Radiology, St Louis Children's Hospital, MO, USA

    T E Herman & M J Siegel

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  1. T E Herman
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  2. M J Siegel
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Correspondence to T E Herman.

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Herman, T., Siegel, M. Congenital dural arteriovenous fistula at torcula Herophili. J Perinatol 27, 730–731 (2007). https://doi.org/10.1038/sj.jp.7211816

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