Cerebellar hemorrhage caused by dural arteriovenous fistula: a review of five cases

Object. In this study the authors performed a retrospective analysis of fiv e cases in which the patients (three women and two men) were treated for in tracranial dural arteriovenous fistulas (AVFs) associated with cerebellar h emorrhage. On the basis of their findings, the authors evaluated the charac teristics of this unusual symptom. Methods. The dural AVFs were located in the right cavernous sinus in one pa tient, the left transverse-sigmoid sinus in three patients, and the right s uperior petrosal sinus (SPS) in one patient. All patients presented with se vere headache and/or loss of consciousness. Computerized tomography scans r evealed a small cerebellar hemorrhage near the fourth ventricle and hydroce phalus in four cases, and a massive hemispheric cerebellar hemorrhage in th e remaining case: The four patients with small hemorrhages underwent ventri culostomy and endovascular treatment, all recovered. The patient suffering from a massive hemorrhage because of a dural AVF in the SPS was treated by suboccipital craniectomy, hematoma evacuation, and removal of the vascular anomaly. This patient remains in a persistent vegetative state. In four cas es, results of angiography demonstrated retrograde leptomeningeal Venous dr ainage through the SPS to the anastomotic lateral mesencephalic vein (ALMV) and/or to the vein of the lateral recess of the fourth ventricle (VLR4V). Retrograde leptomeningeal venous drainage to the ALMV and/or VLR4V was resp onsible for cerebellar hemorrhage in these cases. Conclusions. Thus, it is important to consider dural AVF in cases in which there is even a small hemorrhage near the fourth ventricle accompanied by i ntraventricular perforation and a decreased level of consciousness.