Anterior cranial fossa dural arteriovenous fistula

Case contributed by Peter Mitchell


Sudden onset headache. GCS 14.

Patient Data

Age: 60 years
Gender: Female

Heterogenous predominantly hyperdense subdural hematoma extending along the right cerebral convexity. Anterior left parafalcine subdural hematoma is also seen. Inferior right frontal lobe intraparenchymal hemorrhage with associated edema. 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.

Ethmoidal dural AVF, with feeders 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 hematoma related to an ethmoidal DAVF, with an enhancing venous varix.

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