Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Dural Arteriovenous Fistula of Superior Sagittal Sinus after Tamoxifen Treatment for Breast Cancer

  • Hwang, Sung-Kyun (Department of Neurosurgery, College of Medicine, Ewha Womans University, Mokdong Hospital)
  • Received : 2014.04.29
  • Accepted : 2014.06.21
  • Published : 2015.03.28
Download PDF
⟨ Previous Next ⟩

Abstract

We are reporting an unusual case of dural arteriovenous fistula (AVF) of the superior sagittal sinus (SSS) after tamoxifen treatment for breast cancer. A 30-year-old female arrived at the emergency room with a sudden headache and left sided weakness and sensory loss. In her past medical history, she was diagnosed with breast cancer 1 year prior, and subsequently underwent a breast conserving mastectomy with whole breast radiation and adjuvant chemotherapy with tamoxifen. At the time of admission, computed tomography showed a small acute intracerebral hemorrhage at the right parietal cortex, and magnetic resonance imaging showed that a dural AVF at the SSS with a prominent and tortuous venous enhancement along the centrum semiovale was present. Cerebral angiography showed that the dural AVF at the mid-portion of the SSS with meningeal arterial feeding vessels entering the wall of the SSS, then draining through the dilated cortical veins. Our patient had no signs of active malignancy or any abnormalities in her coagulation profile, so it can be concluded that the tamoxifen was the likely cause of the SSS thrombosis and dural AVF. The dural AVF was treated by an endovascular coil embolization for the arterialized segment of the SSS. The patient dramatically recovered favorably from left side motor and sensory deficit. The best clinical approach is to screen potential patients of tamoxifen hormonal therapy and educate them on the sign and symptoms of life threatening thromboembolic events while taking tamoxifen.

Keywords

References

  1. Akdal G, Dönmez B, Cakmakçi H, Yener GG : A case with cerebral thrombosis receiving tamoxifen treatment. Eur J Neurol 8 : 723-724, 2001 https://doi.org/10.1046/j.1468-1331.2001.00297.x
  2. Awad IA, Little JR, Akarawi WP, Ahl J : Intracranial dural arteriovenous malformations : factors predisposing to an aggressive neurological course. J Neurosurg 72 : 839-850, 1990 https://doi.org/10.3171/jns.1990.72.6.0839
  3. Bushnell C : The cerebrovascular risks associated with tamoxifen use. Expert Opin Drug Saf 4 : 501-507, 2005 https://doi.org/10.1517/14740338.4.3.501
  4. Cognard C, Casasco A, Toevi M, Houdart E, Chiras J, Merland JJ : Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow. J Neurol Neurosurg Psychiatry 65 : 308-316, 1998 https://doi.org/10.1136/jnnp.65.3.308
  5. Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, et al. : Cerebral dural arteriovenous fistulas : clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194 : 671-680, 1995 https://doi.org/10.1148/radiology.194.3.7862961
  6. Cognard C, Januel AC, Silva NA Jr, Tall P : Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage : new management using Onyx. AJNR Am J Neuroradiol 29 : 235-241, 2008 https://doi.org/10.3174/ajnr.A0817
  7. D'Angelo-Donovan D, Guarino MJ : Sagittal sinus thrombosis while on tamoxifen requiring craniectomy. Del Med J 84 : 31-32, 2012
  8. Davies MA, Saleh J, Ter Brugge K, Willinsky R, Wallace MC : The natural history and management of intracranial dural arteriovenous fistulae. Part 1 : benign lesions. Interv Neuroradiol 3 : 295-302, 1997 https://doi.org/10.1177/159101999700300404
  9. Davies MA, Ter Brugge K, Willinsky R, Wallace MC : The natural history and management of intracranial dural arteriovenous fistulae. Part 2 : aggressive lesions. Interv Neuroradiol 3 : 303-311, 1997 https://doi.org/10.1177/159101999700300405
  10. Davies MA, TerBrugge K, Willinsky R, Coyne T, Saleh J, Wallace MC : The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85 : 830-837, 1996 https://doi.org/10.3171/jns.1996.85.5.0830
  11. Duvelleroy Hommet C, De Toffol B, Corcia P, Autret A : Cerebral venous thrombosis and estrogen-progesterone therapy. Eur Neurol 39 : 245-247, 1998
  12. Fatehi F, Saadatnia M, Zare M : Cerebral venous sinus thrombosis following tamoxifen prescription. Neurosciences (Riyadh) 13 : 320, 2008
  13. Finelli PF : Thrombosis of the cerebral veins and sinuses. N Engl J Med 353 : 314-315, 2005 https://doi.org/10.1056/NEJM200507213530319
  14. Finelli PF, Schauer PK : Cerebral sinus thrombosis with tamoxifen. Neurology 56 : 1113-1114, 2001
  15. Halbach VV, Higashida RT, Hieshima GB, Rosenblum M, Cahan L : Treatment of dural arteriovenous malformations involving the superior sagittal sinus. AJNR Am J Neuroradiol 9 : 337-343, 1988
  16. King WA, Martin NA : Intracerebral hemorrhage due to dural arteriovenous malformations and fistulae. Neurosurg Clin N Am 3 : 577-590, 1992
  17. Liu JK, Choudhry OJ, Barnwell SL, Delashaw JB Jr, Dogan A : Single stage transcranial exposure of large dural venous sinuses for surgically-assisted direct transvenous embolization of high-grade dural arteriovenous fistulas : technical note. Acta Neurochir (Wien) 154 : 1855-1859, 2012 https://doi.org/10.1007/s00701-012-1462-6
  18. Masjuan J, Pardo J, Callejo JM, Andres MT, Alvarez-Cermeno JC : Tamoxifen : a new risk factor for cerebral sinus thrombosis. Neurology 62 : 334-335, 2004 https://doi.org/10.1212/01.WNL.0000103294.81923.12
  19. Meier CR, Jick H : Tamoxifen and risk of idiopathic venous thromboembolism. Br J Clin Pharmacol 45 : 608-612, 1998 https://doi.org/10.1046/j.1365-2125.1998.00733.x
  20. Meyer MA : Cerebral sinus thrombosis with tamoxifen. Neurology 57 : 2150, 2001
  21. Raizer JJ, DeAngelis LM : Cerebral sinus thrombosis diagnosed by MRI and MR venography in cancer patients. Neurology 54 : 1222-1226, 2000 https://doi.org/10.1212/WNL.54.6.1222
  22. Saphner T, Tormey DC, Gray R : Venous and arterial thrombosis in patients who received adjuvant therapy for breast cancer. J Clin Oncol 9 : 286-294, 1991 https://doi.org/10.1200/JCO.1991.9.2.286

Cited by

  1. Spontaneous Resolution of Venous Aneurysms After Transarterial Embolization of a Variant Superior Sagittal Sinus Dural Arteriovenous Fistula : Case Report and Literature Review vol.22, pp.5, 2015, https://doi.org/10.1097/nrl.0000000000000137
  2. Cyclosporin A-related cerebral venous sinus thrombosis : A case report vol.97, pp.31, 2015, https://doi.org/10.1097/md.0000000000011642
  3. Chemotherapy associated dural sinus thrombosis presenting as a cerebrospinal fluid leak vol.13, pp.6, 2020, https://doi.org/10.1136/bcr-2020-235240
  4. A Comprehensive Analysis of Dural Arteriovenous Fistula Involving the Superior Sagittal Sinus: A Systematic Review vol.15, pp.1, 2015, https://doi.org/10.5797/jnet.ra.2020-0085
  5. Cyclosporine-A-Induced Intracranial Thrombotic Complications: Systematic Review and Cases Report vol.11, pp.None, 2015, https://doi.org/10.3389/fneur.2020.563037