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Figures
- FIG 1.
Case 1. A 57-year-old Asian man who presented with several weeks of progressive myelopathy. A, Conventional angiography shows a craniocervical junction AVF (white circle) with a large arterialized draining vein (arrowhead) arising from the dura adjacent to the point where the vertebral artery pierces the dura, supplied by branches of the left vertebral artery (arrow). B, The same injection demonstrates the venous drainage of the fistula down the anterior and posterior spinal veins, which are filled early (arrowhead). C, A right ICA injection, anterior-posterior view shows incidental occlusion of the M1 segment with Moyamoya-like collaterals (white circle) reconstituting the distal MCA territory in addition to leptomeningeal collaterals (arrowhead) from the distal anterior cerebral artery. He underwent surgical ligation of the fistula after failed embolization. The asymptomatic MCA occlusion was treated medically.
- FIG 2.
Case 2. A 63-year-old Asian man who presented with multiple left-hemisphere infarcts during 1 year. A, A left common carotid artery injection shows a left sphenoparietal DAVF (circle) supplied by the left middle meningeal artery with exclusive retrograde cortical venous drainage (arrowheads). B, There is delayed filling of the left ICA (arrow), which is occluded distal to the origin of the ophthalmic artery (arrowheads). C, Selective right ICA injection, lateral view, shows severe stenosis of the right supraclinoid ICA (arrows). The patient underwent partial embolization of the DAVF followed by surgical ligation and left superficial temporal artery–to-MCA bypass.
- FIG 3.
Case 3, A 74-year-old Asian woman who presented with episodic vision loss, papilledema, and cognitive decline. A, Conventional angiography, selective left ICA injection, shows an incidental left supraclinoid ICA occlusion as well as a left transverse-sigmoid junction DAVF with arterial feeders from the left meningohypophyseal artery (arrows). B, External carotid artery injection, lateral view, shows a high-flow transverse-sigmoid sinus DAVF. The DAVF was occluded via a transvenous approach with resolution of symptoms at follow up. Low-dose aspirin was prescribed for the incidental carotid occlusion.
- FIG 4.
Case 4. A 42-year-old Asian man with right-sided headache. A, Selective right ICA injection, anterior-posterior view, early arterial phase, shows occlusion of the MCA with a Moyamoya network (white circle). B, Selective right ICA injection, lateral view, early arterial phase, shows a lack of opacification in the MCA territory and early filling of the superior sagittal sinus (arrowheads). C, Right ICA selective injection, magnified oblique view, shows enlarged and tortuous distal ophthalmic artery branches (arrowheads) feeding a dural/pial AVF (white circle), with early opacification of a cortical vein draining into the superior sagittal sinus.
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