Simultaneous unilateral moyamoya disease and ipsilateral dural arteriovenous fistula: Case report
OBJECTIVE: Previous reports have described an association between moyamoya disease and arteriovenous malformations, but this unusual case is the first report of a unilateral moyamoya pattern simultaneously associated with an ipsilateral dural arteriovenous fistula (dAVF). CLINICAL PRESENTATION: A 44-year-old man presented with headache, tinnitus, and an intraventricular hemorrhage, as seen on computer tomography. Cerebral angiography showed a right moyamoya pattern and an ipsilateral dAVF fed by branches of the external carotid artery and draining into the transverse sinus. INTERVENTION: After the intraventricular hemorrhage resolved, the patient underwent transarterial embolization of the dAVF with Onyx, followed by a direct superficial temporal artery-to-middle cerebral artery bypass. Subsequent reconstitution of the dAVF required transvenous embolization, which obliterated the dAVF. At his 2-month follow-up examination, the patient was asymptomatic and neurologically intact. CONCLUSION: Recent investigations have established that both moyamoya disease and dAVFs are associated with dural angiogenesis. These factors may represent a mechanism for vaso-occlusive ischemia contributing to the formation of dAVF. Thte extremely rare coincidental presentation may have deeper pathogenic implications.
Killory, BD; Gonzalez, LF; Wait, SD; Ponce, FA; Albuquerque, FC; Spetzler, RF
Volume / Issue
Start / End Page
International Standard Serial Number (ISSN)
Digital Object Identifier (DOI)