title: Endovascular treatment of traumatic high flow dural arterio-venous fistula involving the middle meningeal artery and facial veins.
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.
authors.affiliation: Department of Neuroradiology, University of Erlangen Medical School, Schwabachanlage 6, 91054 Erlangen, Germany. janine.rennert@nrad.imed.uni-erlangen.de
authors.forename: Janine
authors.initials: J
authors.lastname: Rennert
authors.forename: Marcel
authors.initials: M
authors.lastname: Seiz
authors.forename: Christopher
authors.initials: C
authors.lastname: Nimsky
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods*; D003097:Collateral Circulation / Q000502:physiology; D004556:Electric Injuries / Q000000981:diagnostic imaging*; D004621:Embolization, Therapeutic / Q000379:methods*; D005145:Face / Q000098:blood supply*; D005151:Facial Injuries / Q000000981:diagnostic imaging*; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008576:Meningeal Arteries / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging; D019291:Skull Base / Q000000981:diagnostic imaging / Q000293:injuries; D012887:Skull Fractures / Q000000981:diagnostic imaging; D054063:Superior Sagittal Sinus / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014680:Veins