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Metachronous dural arteriovenous fistulas in a single patient: a 25-year evolution of three distinct lesions

Year: 2026

Type: article

Abstract: A rare case of metachronous dural arteriovenous fistulas (DAVFs) over 25 years is presented. The patient initially developed a left transverse-sigmoid sinus DAVF causing pulsatile tinnitus, successfully treated with embolisation. 14 years later, he experienced pulsatile scalp lesions, numbness and muscle weakness on the right side, impairing his handwriting. Angiography revealed a superior sagittal sinus DAVF with cortical vein reflux and sinus thrombosis, treated with transvenous and transarterial embolisation, leading to significant symptom improvement. Five years later, he reported right occipital pain, retromastoid tenderness and occasional tinnitus. Imaging confirmed a new DAVF on the right transverse-sigmoid sinus (Cognard type I). He declined further treatment but remained clinically stable with unchanged MRI findings for 8 years. This case highlights the complexity of managing recurrent, metachronous DAVFs and the importance of long-term monitoring.

Source: BMJ Case Reports

DOI: 10.1136/bcr-2025-271253

Author: Hon-Man Liu

Institutions: Fu Jen Catholic University, National Taiwan University Hospital

Language: English

Topic: Vascular Malformations Diagnosis and Treatment

Subfield: Clinical Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

OpenAlex ID: W7223081672