Presentation
History of remote head trauma. Now she complains of fainting attacks and right sided weakness.
Patient Data
A left-sided dural arteriovenous fistula is demonstrated fed by external carotid (middle meningeal) branches with prominent cortical vein enlargement. No evidence of vascular nidus.
The enlarged veins drain subsequently into the superior sagittal sinus.
This image demonstrates direct communication between middle meningeal artery branches and the enlarged draining cortical veins without nidus in between. (Circle)
Case Discussion
Dural arteriovenous fistulas (dAVF) are a heterogeneous collection of conditions that share arteriovenous shunts from dural vessels. They present variably with hemorrhage or venous hypertension, and can be challenging to treat.
Typically, they are supplied by multiple feeders from arteries that supply the relevant part of the meninges and regional scalp vessels that often give transosseous branches:
- supratentorial and lateral: (external carotid artery)
- middle meningeal artery
- superficial temporal artery (transosseous branches)
- anterior cranial fossa: (internal carotid artery)
- ethmoidal branches of the ophthalmic artery
- cavernous sinus: (internal and external carotid arteries)
- posterior cranial fossa: (vertebral and external carotid arteries)
- vertebral arteries (both dural and muscular branches)
- occipital and ascending pharyngeal arteries
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