title: Dural Arteriovenous Fistula of the Sinus of the Lesser Sphenoid Wing Presenting with Pontine Hemorrhage.
abstract: BACKGROUND
  Dural arteriovenous fistulas (DAVFs) of the sinus of the lesser sphenoid wing (SLSW) with leptomeningeal drainage are rare. We report a patient with a DAVF of the SLSW draining into the basal vein of Rosenthal (BVR) presenting with pontine hemorrhage.
  
  
  METHODS
  A 71-year-old man presented with sudden right hemisensory disturbance of the arm and leg. Brain computed tomography scan showed left pontine hemorrhage, and cerebral angiography revealed a DAVF of the left SLSW. The fistula drained solely into the left BVR, which had an anastomosis to the left lateral mesencephalic vein, which had a varix invaginated into the left pons. The diagnosis was a DAVF of the left SLSW drained into the lateral mesencephalic vein via the bridging vein of the left SLSW, the deep middle cerebral vein, and the BVR, and a varix of the lateral mesencephalic vein caused pontine hemorrhage. The fistula was occluded by clipping through frontotemporal craniotomy. The postoperative course was uneventful, and postoperative cerebral angiography confirmed disappearance of the fistula.
  
  
  CONCLUSIONS
  A DAVF of the SLSW presenting with pontine hemorrhage is extremely rare, and DAVFs with deep leptomeningeal drainage should be included among a variety of etiologies of pontine hemorrhage.
authors.affiliation: Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan. Electronic address: hikkinakajima@yahoo.co.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Neurointervention, Osaka City General Hospital, Osaka, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Ishiguro
authors.affiliation: Department of Neurointervention, Osaka City General Hospital, Osaka, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Terada
authors.affiliation: Department of Neurointervention, Osaka City General Hospital, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Komiyama
mesh_terms: D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D002533:Cerebral Angiography; D003399:Craniotomy / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010256:Paranasal Sinuses / Q000473:pathology*; D011149:Pons / Q000000981:diagnostic imaging / Q000473:pathology*; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Basal vein of Rosenthal; Dural arteriovenous fistula; Pontine hemorrhage; Sinus of lesser sphenoid wing