Korean J Neurotrauma.  2015 Oct;11(2):151-153. 10.13004/kjnt.2015.11.2.151.

Iatrogenic Dural Arteriovenous Fistula after Superficial Temporal Artery to Middle Cerebral Artery Anastomosis: A Case Report

• Kim SW
• Chae KS
• Shim JH
• Rho SJ
• Choi HK
• Park HS

• KMID: 2378276
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.151

Abstract

Dural arteriovenous fistulas (AVFs) are uncommon, representing only 10% to 15% of all intracranial AVFs. Here we present the case of a patient with cerebral infarction who experienced a dural AVF after craniotomy for superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery. A 48-year-old man presented with dysarthria and right side hemiparesis. A brain magnetic resonance imaging scan revealed multiple acute infarctions and severe stenosis of the left MCA. Therefore, STA-MCA bypass surgery was performed. A follow-up angiography performed 2 weeks after the surgery showed an abnormal vascular channel from the left middle meningeal artery (MMA) to the middle meningeal vein (MMV) just anterior to the border of the craniotomy margin. This fistula originated from a screw used for cranial fixation. The screw injured the MMA and MMV, and this resulted in the formation of a fistula. The fistula was successfully treated with transarterial embolization. Surgeons should be careful when fixing bones with screws and plates as fistulas can develop if vessels are injured.

Keyword

Central nervous system vascular malformations; Cerebral revascularization; Meningeal arteries; Middle cerebral artery

MeSH Terms

Angiography
Brain
Central Nervous System Vascular Malformations*
Cerebral Infarction
Cerebral Revascularization
Constriction, Pathologic
Craniotomy
Dysarthria
Fistula
Follow-Up Studies
Humans
Infarction
Magnetic Resonance Imaging
Meningeal Arteries
Middle Aged
Middle Cerebral Artery*
Paresis
Temporal Arteries*
Veins

Figure

• 

  FIGURE 1 A: Diffusion-weighted magnetic resonance imaging revealed multiple acute infarctions in left basal ganglia and frontoparietal lobe. B: Preoperative anteroposterior angiogram of the left internal carotid artery demonstrating severe stenosis of the left middle cerebral artery. C: Preoperative lateral angiogram of the left external carotid artery demonstrating no evidence of a dural arteriovenous fistula.

• 

  FIGURE 2 A: Lateral angiogram of the left external carotid artery obtained 2 weeks after superficial temporal artery to middle cerebral artery anastomosis demonstrating the craniotomy site and the screw (black arrow). B: The arteriovenous fistula from the middle meningeal artery (B, white arrow) caused by the screw (black arrow, same point as that in A). C: Transarterial coil embolization is performed (white arrowhead).

Reference

1. Ahn JY, Kim OJ, Joo YJ, Joo JY. Dural arteriovenous malformation occurring after craniotomy for pial arteriovenous malformation. J Clin Neurosci. 2003; 10:134–136. PMID: 12464548.

2. Chandrashekar HS, Nagarajan K, Srikanth SG, Jayakumar PN, Vasudev MK, Pandey P. Middle meningeal arteriovenous fistula and its spontaneous closure. A case report and review of the literature. Interv Neuroradiol. 2007; 13:173–178. PMID: 20566146.

3. Hashimoto H, Iida J, Masui K, Nishi N, Yonezawa T, Sakaki T. Dural arteriovenous malformation of the anterior cranial fossa occurring after bifrontal craniotomy. Surg Neurol. 1998; 49:47–50. PMID: 9428894.

4. Inagawa T, Takeda T, Taguchi H, Kamiya K, Yamada T. Traumatic middle meningeal arteriovenous fistula caused by three-point skull fixation. Case report. J Neurosurg. 1984; 60:853–855. PMID: 6707757.

5. Nabors MW, Azzam CJ, Albanna FJ, Gulya AJ, Davis DO, Kobrine AI. Delayed postoperative dural arteriovenous malformations. Report of two cases. J Neurosurg. 1987; 66:768–772. PMID: 3572502.

6. Pappas CT, Zabramski JM, Shetter AG. Iatrogenic arteriovenous fistula presenting as a recurrent subdural hematoma. Case report. J Neurosurg. 1992; 76:134–136. PMID: 1727151.

7. Vadivelu S, Xin X, Loven T, Restrepo G, Chalif DJ, Setton A. Iatrogenic dural arteriovenous fistula and aneurysmal subarachnoid hemorrhage. Neurosurg Focus. 2012; 32:E1. PMID: 22537118.

8. Yassari R, Jahromi B, Macdonald R. Dural arteriovenous fistula after craniotomy for pilocytic astrocytoma in a patient with protein S deficiency. Surg Neurol. 2002; 58:59–64. PMID: 12361657.