Anterior cranial fossa dural arteriovenous fistula

Case contributed by Prof Peter Mitchell

Presentation

Sudden onset headache. GCS 14

Patient Data

Age: 60 years
Gender: Female

CT brain

Modality: CT

Heterogenous predominantly hyperdense subdural haematoma extending along the right cerebral convexity. Anterior left parafalcine subdural haematoma is also seen. Inferior right frontal lobe intraparenchymal haemorrhage with associated oedema. Mass effect with midline shift to the left, partial effacement of the anterior horn and body of right lateral ventricle. No evidence of hydrocephalus.

Contrast enhancing, lobulated mass is seen in the anterior inferior right frontal lobe. The extracranial vessels, circle of Willis and vertebrobasilar system opacify normally.

No evidence of aneurysm, dissection or significant stenosis.

Modality: DSA (angiography)

Ethmoidal dural AVF, with feeder coming off:

  • bilateral ophthalmic arteries.
  • bilateral external carotid arteries most likely from the ethmoidal and nasal cavity branches coming off the internal maxillary arteries.

Venous varicosity noted, with a large varix measuring approximately 12 mm x 8 mm.

Venous drainage noted into the rostral part of the superior sagittal sinus. 

No further abnormality is identified.

Case Discussion

This case illustrates the typical site of frontal haematoma related to an ethmoidal DAVF, with an enhancing venous varix.

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Case Information

rID: 22220
Case created: 20th Mar 2013
Last edited: 15th Sep 2015
Inclusion in quiz mode: Included

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