A Complex, Convexity, Anterior Superior Sagittal Sinus Dural Arteriovenous Fistula Secondary to Venous Sinus Thrombosis

We report the management of a convexity dural arteriovenous fistula (dAVF) in an uncommon anterior superior sagittal sinus (SSS) location. This was a high-risk Cognard IIa+b dAVF, which is notoriously complex to treat. Endoscopic management alone for complex SSS dAVFs is challenging due to the often bilateral arterial supply to the fistula, as demonstrated in this case. Hence, proceeding straight to surgery is a viable option, skipping the need for interventional radiological (IR) coiling. This is the first reported case of a fistula secondary to venous sinus thrombosis in a coeliac patient. Our patient initially underwent endoscopic treatment, which failed due to arterial supply from other arteries continuing to supply the fistula. The patient then underwent a midline craniotomy where the feeding arteries were ligated, followed by division of the anterior third of the SSS, allowing further division and ligation of arterial feeders. It is essential to be aware of the prothrombotic state of coeliacs and the risk of thrombosis and fistula formation. This allows physicians to recognize the signs of raised intracranial pressure, facilitating early intervention.