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Wibawa, Gibran Aditiara
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Medicine & Pharmacology

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Intracranial dural arteriovenous fistula presenting like longitudinally extensive transverse myelitis Yuliatri, Nia; Widjaya, Ingrid Ayke; Wibawa, Gibran Aditiara; Harlyjoy, Alphadenti; Satyanegara
Medical Journal of Indonesia Vol. 33 No. 4 (2024): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.cr.247543

Abstract

Intracranial dural arteriovenous fistula (DAVF) that drains into spinal perimedullary veins can generate longitudinally extensive transverse myelitis (LETM)-like lesion, which often represents a significant diagnostic and therapeutic challenge. This is a case report of a 50-year-old male referred with all extremity weaknesses. Despite receiving high-dose intravenous steroids for suspected myelitis, no improvement was recorded. Spinal imaging showed abnormal hyperintensity extending from the T6 vertebral level to the medulla, and a flow void lesion from the cervicomedullary junction up to the L3 level. Angiography confirmed a Cognard type V spinal DAVF, which was treated with transarterial embolization of the feeding vessel. Follow-up angiography showed complete occlusion of the fistula without any backflow. Flow voids are no longer visible on MRI conducted 3 weeks post-procedure. Unfamiliarity with these disorders often leads to delays in diagnosis and treatment. Therefore, it is essential to consider intracranial DAVF as a differential diagnosis for LETM-like lesions.
Transventricular transforaminal endoscopic fenestration with cysto-ventriculoperitoneal shunt to manage a third ventricular arachnoid cyst: a case report Yuliatri, Nia; Widjaya, Ingrid Ayke; Harlyjoy, Alphadenti; Wibawa, Gibran Aditiara; Satyanegara
Medical Journal of Indonesia Vol. 32 No. 3 (2023): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.cr.236856

Abstract

Regular ventriculoperitoneal (VP) shunt is commonly used as the first option to manage a third ventricular arachnoid cyst due to the lack of facilities, unfamiliarity with endoscopic techniques, or misdiagnosis as purely obstructive hydrocephalus. A 9-year-old girl with obstructive hydrocephalus due to a third ventricular arachnoid cyst was treated with a VP shunt. 2 months later, the previous shunt device was removed due to an infection. Following a sterile cerebrospinal fluid analysis culture, we conducted a navigation-assisted transventricular transforaminal endoscopic fenestration and cysto-VP programmable shunt placement. A decrease in ventricular dilatation was seen on follow-up. This approach was justified due to the possibility of establishing communication with normal cisterns, the high rate of cyst elimination, and the potential for achieving shunt independence. Performing an endoscopic fenestration followed by cysto-VP shunt placement could be an optimal option for managing this condition.
Co-Authors Harlyjoy, Alphadenti Nia Yuliatri Satyanegara Widjaya, Ingrid Ayke