Complex dural arteriovenous fistula in Bannayan-Riley-Ruvalcaba syndrome

Case report

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In this paper the authors report the case of a complex dural arteriovenous fistula (dAVF) with high-risk features in a 14-year-old girl with Bannayan-Riley-Ruvalcaba syndrome (BRRS), a phosphatase and tensin homolog–associated syndrome, presenting with signs and symptoms of increased intracranial pressure (ICP) that had previously been attributed to pseudotumor cerebri. This fistula was obliterated following 2 stages of embolization, and the patient experienced immediate symptomatic improvement. At the 2-month follow-up evaluation, the fistula remained angiographically occluded, and her symptoms continue to improve. This is the third reported case of an intracranial dAVF in a patient with BRRS. Because high-risk dAVFs can result in devastating morbidity, early detection with vascular imaging is crucial for patients with BRRS presenting with signs of increased ICP. Goals of treatment should include complete fistula obliteration whenever possible.

Abbreviations used in this paper:ACA = anterior cerebral artery; AVF = arteriovenous fistula; BRRS = Bannayan-Riley-Ruvalcaba syndrome; dAVF = dural AVF; ECA = external carotid artery; ICA = internal carotid artery; ICP = intracranial pressure; MMA = middle meningeal artery; PTEN = phosphatase and tensin homolog; SSS = superior sagittal sinus.
Article Information

Contributor Notes

Address correspondence to: Felipe C. Albuquerque, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@dignityhealth.org.Please include this information when citing this paper: published online May 10, 2013; DOI: 10.3171/2013.3.PEDS12551.
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