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J Neurosurg Pediatr. 2015 Jul;16(1):74-9. doi: 10.3171/2014.12.PEDS145. Epub 2015 Apr 24.

The role of percutaneous embolization techniques in the management of dural sinus malformations with atypical angioarchitecture in neonates: report of 2 cases.

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Department of Radiology.
Department of Neurosurgery, and.
Department of Neurology, University of Minnesota, Minneapolis, Minnesota.


Dural sinus malformations (DSMs) are rare congenital malformations that can be midline or lateral in location. Midline DSMs have been reported to have a worse prognosis than lateral DSMs and have traditionally been more difficult to manage. The authors report 2 unusual manifestations of midline DSMs and their management with percutaneous transfontanelle embolization. The first patient (Case 1) presented at 21 days of life with a large midline DSM and multiple highflow dural and pial arteriovenous shunts. The child developed congestive cardiac failure and venous congestion with intracranial hemorrhage and seizures within a few weeks. The second patient (Case 2) presented with a large midline DSM found on prenatal imaging that was determined to be a purely venous malformation on postnatal evaluation. This large malformation resulted in consumptive coagulopathy and apneic episodes from brainstem compression. The patient in Case 1 was treated initially with endovascular embolization and eventually with curative percutaneous-transfontanelle embolization. The patient in Case 2 was treated with percutaneous transfontanelle embolization in combination with posterior fossa decompression and cranial expansion surgery.


AV = arteriovenous; CCA = common carotid artery; DSA = digital subtraction angiography; DSM = dural sinus malformation; MMA = middle meningeal artery; MVP = midline venous pouch; NBCA = N-butyl cyanoacrylate; SSS = superior sagittal sinus; VA = vertebral artery; arteriovenous fistula; dural sinus malformation; pediatric arteriovenous malformation; percutaneous embolization; vascular disorders

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