Intra-operative emergence of occult dural arteriovenous fistula after middle meningeal artery embolization for chronic subdural hematoma: Case report and literature review

Armin Tavakkoli; Julio D Montejo; Daniel R Calnan; Timothy C Ryken; Clifford J Eskey

doi:10.1016/j.radcr.2021.12.012

Intra-operative emergence of occult dural arteriovenous fistula after middle meningeal artery embolization for chronic subdural hematoma: Case report and literature review

Radiol Case Rep. 2022 Mar 3;17(5):1470-1474. doi: 10.1016/j.radcr.2021.12.012. eCollection 2022 May.

Authors

Armin Tavakkoli¹, Julio D Montejo², Daniel R Calnan², Timothy C Ryken^{2

1}, Clifford J Eskey^{2

1}

Affiliations

¹ Geisel School of Medicine at Dartmouth, Hanover, NH, 03755 Lebanon.
² Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, NH, 03766 Lebanon.

Abstract

Dural arteriovenous fistulae of the middle meningeal artery (MMA-dAVF) are high risk lesions that can lead to intracranial hemorrhage. We describe the case of an adult male that presented with chronic subdural hematomas and was treated with burr hole craniotomy plus middle meningeal artery (MMA) embolization. Although the pre-embolization angiogram showed no signs of a fistula, a fistula arising from the MMA and draining into the superior sagittal sinus emerged intra-operatively. To our knowledge, this is the first case of intra-operative emergence of occult MMA-dAVF with intracranial drainage during MMA embolization for chronic subdural hematoma treatment. This observation supports monitoring for and embolizing spontaneous MMA-dAVF following MMA embolization.

Keywords: Dural arteriovenous fistula; Intra-operative emergence; Middle meningeal artery embolization.

Publication types

Case Reports