Cerebellar hyperperfusion following endovascular obliteration of dural arteriovenous fistula: illustrative case

BACKGROUND: Cerebral hyperperfusion after reconstructive surgery can develop intracerebral hemorrhage. However, there is no previous report of cerebellar hyperperfusion after surgical treatment for dural arteriovenous fistula (DAVF). In this report, the authors describe a case of cerebellar hyperperfusion following endovascular obliteration of DAVF. OBSERVATIONS: A man in his 70s had a progressing cognitive disturbance. Preoperative angiography showed a high-grade DAVF at the right sigmoid sinus with occlusion of the ipsilateral internal jugular vein. Since the superior sagittal sinus (SSS) was also occluded and the left transverse sinus (TS) exhibited severe stenosis, the bilateral cerebellum exhibited severe venous congestion. Preoperative brain perfusion SPECT showed severely reduced cerebrovascular reactivity to acetazolamide in the bilateral cerebellum. Transvenous transluminal angioplasty of the left TS and SSS and coil embolization of the right sigmoid sinus were performed. While the patient did not develop new neurological deficits, postoperative brain perfusion SPECT showed increased cerebral blood flow in the bilateral cerebellum up to 210% compared to that before the endovascular treatment. Blood pressure was strictly controlled, and then cerebellar hyperperfusion recovered on postoperative day 7. LESSONS: Cerebellar hyperperfusion can develop after surgical treatment for DAVF. Therefore, careful evaluation of preoperative hemodynamics, even in the posterior fossa, may be important. https://thejns.org/doi/10.3171/CASE26342.