title: Iatrogenic Dural Arteriovenous Fistula after Superficial Temporal Artery to Middle Cerebral Artery Anastomosis: A Case Report.
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.
authors.affiliation: Department of Neurosurgery, Bongseng Memorial Hospital, Busan, Korea.
authors.forename: Seng-Won
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Bongseng Memorial Hospital, Busan, Korea.
authors.forename: Kil-Sung
authors.initials: KS
authors.lastname: Chae
authors.affiliation: Department of Neurosurgery, Bongseng Memorial Hospital, Busan, Korea.
authors.forename: Jae-Hyon
authors.initials: JH
authors.lastname: Shim
authors.affiliation: Department of Neurosurgery, Bongseng Memorial Hospital, Busan, Korea.
authors.forename: Seung-Jin
authors.initials: SJ
authors.lastname: Rho
authors.affiliation: Department of Neurosurgery, Bongseng Memorial Hospital, Busan, Korea.
authors.forename: Hak-Ki
authors.initials: HK
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Bongseng Memorial Hospital, Busan, Korea.
authors.forename: Hwa-Seung
authors.initials: HS
authors.lastname: Park
keywords: Central nervous system vascular malformations; Cerebral revascularization; Meningeal arteries; Middle cerebral artery