Endovaskuläre Versorgung einer traumatischen duralen arterio-venösen Fistel unter Beteiligung der Arteria meningea media und facialer Venen

Abstract

Dural arterio-venous fistulas are rare lesions. Traumatic dural AV-fistulas in particular, are very rare complications of head and neck trauma.

We report on a 59-year old man with a severe facial and head trauma. Initial computed tomography demonstrated a left frontal subdural hematoma, leading to progressive midline shift. Additionally, a complex skull base fracture was present, involving the frontal, temporal and sphenoid bone. A few days after the accident the patient reported a left pulsatile tinnitus. Subsequent selective carotid angiography revealed a high flow dural arterio-venous fistula involving the middle meningeal artery and facial veins. Complete endovascular embolization was performed by a transarterial approach using microparticles and an electrolytically detachable coil resulting in an immediate disappearance of the tinnitus.

Remarkably, this case nicely illustrates possible “dangerous” collateral circulation to the ophthalmic artery–a feature that should be kept in mind during endovascular treatment of this entity.