Arteriovenous fistula of superficial temporal vessels

Abstract

We present a case of patient with a rare vessel pathology -arteriovenous fistula (AVF) of superficial temporal artery and vein. The 56-year-old man was admitted to the Department of Neurology because of a headache in the right temporal region with concomitant buzzing sound in his right ear. The pain was present mainly in the evenings and was stronger when touching the temporal region. He denied having any head injury in the last few years. There were no signs of central nervous system involvement in the neurological examination. Within the right temporal area a subcutaneous mass with redness of the surrounding skin and with palpable and audible pulsatile thrill was observed. In computed tomography (CT) of the head no abnormalities were found. In duplex-Doppler ultrasound examination of carotid arteries the systolic blood velocity in the right external carotid artery was over two times higher than in the left one. Its flow profile was turbulent and low-resistant. In CT angiography (CTA) an AVF between superficial temporal artery and vein was revealed -it was located at the level of the right zygomatic arch. In both CTA and magnetic resonance angiography, no abnormal connections between extra-and intracranial vessels were found. The patient underwent surgery with good result -all the symptoms disappeared. AVFs of vessels of the scalp are rare and their aetiology is mainly traumatic or iatrogenic. By describing this case we wanted to draw attention to less frequent causes of headache. (Folia Morphol 2019; 78, 4: 879-882)

Fístula arteriovenosa traumática em região temporal: um desafio terapêutico

“…Analyzing just those traumatic AVF that involve the scalp, it is found that the superficial temporal artery is the most often affected, along with the occipital artery and its corresponding veins. 2 Whereas the intracranial vessels are most frequently affected in congenital cases, the opposite is true in traumatic cases, in which facial circulation is most affected because of its greater susceptibility, as described in the case reported here in which the patient had an AVF in the left temporal region.…”

“…Ao analisar as FAV traumáticas apenas do couro cabeludo, percebeu-se que a artéria temporal superficial é a mais envolvida, bem como a artéria occipital e suas veias correspondentes 2 . Apesar de nos casos congênitos, os vasos intracranianos serem mais acometidos, em casos de trauma ocorre o contrário, sendo a circulação da face mais afetada, por apresentar maior suscetibilidade, como relatado nesse caso, uma vez que o paciente apresentou FAV na região temporal esquerda.…”

“…AVFs caused by vascular trauma are frequently the consequence of penetrating trauma and are more rarely caused by blunt traumas; they may be diagnosed many years after the traumatic event. 2 The principal etiology is penetrating trauma, in 90% of cases, with blunt traumas responsible for the remaining 10% of cases. Percutaneous interventions, such as renal biopsies, cardiac catheterization, and orthopedic procedures are iatrogenic etiologies.…”

“…As lesões vasculares traumáticas representam um desafio cirúrgico. As FAV decorrentes do trauma vascular frequentemente são consequência do trauma penetrante e mais raramente do trauma contuso, podendo ser diagnosticadas muitos anos depois do evento traumático 2 . A principal etiologia é o trauma penetrante em 90% dos casos, e o trauma contuso é responsável pelos outros 10% dos casos.…”

Traumatic Arteriovenous Fistula of Superficial Temporal Vessel: A Rare Case Report

“…Physical examination findings are: dilated and tortuous vessel, bruit on auscultation of the mass, pulsatile vibration on palpation, and Terrier’s sign. 5 One should consider superficial temporal arteriovenous fistula for possible cause of unilateral headache if patient felt bruit in ipsilateral ear.…”