Abstract
RATIONALE: Dural arteriovenous fistulas (DAVFs), are rare intracranial arteriovenous malformations which are depicted with direct shunts between meningeal arteries and dural sinuses, dural veins, or cortical veins. We reported a rare case of DAVF in the foramen magnum (FM) which was drained by the jugular veins and the perimedullary veins. PATIENT CONCERNS: A 53-year-old male patient was admitted at the Department of Neurosurgery, West China Hospital 5 hours after experiencing a severe headache. His neck was stiff and Brudzinski and Kernigs signs where positive indicating meningeal irritation. DIAGNOSES: An emergency computer tomography scan showed subarachnoid hemorrhage while digital subtraction angiography revealed DAVF in the FM. INTERVENTIONS: Endovascular therapy which comprised of superselective arteriography and whole brain angiography under general anesthesia was successfully carried out. OUTCOMES: Post-embolization angiography showed that the DAVF in the FM area disappeared. Also, whole brain angiography was performed and no other anomalies where detected. The patient recovered with no further neurological deficits and 2 years follow-up revealed the patent is well and go about his daily duties. LESSONS: DAVF in the FM region can be characterized with primary contralateral internal jugular drainage with minor perimedullary involvement.