Traumatic arteriovenous fistulae of the middle meningeal artery and neighbouring veins or dural sinuses

Abstract

Systematic review of the cerebral angiograms of 446 head trauma patients (1971-1978) revealed the presence of an arteriovenous (AV) fistula of the middle meningeal artery (MMA) in 8 cases (1.8%), the total number of angiographically demonstrable injuries of the MMA being 18 (4%). AV fistulae of the MMA may prevent formation of epidural haematoma, but they are frequently associated with so severe damage to skull and brain that prognosis is nevertheless grave. A close relationship between the tighter adherence of the dura to bone in older age and development of an AV fistula of the MMA following trauma to the skull may be presumed.

Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations

“…23,24 DAVFs of the lesser sphenoid wing are often considered to be abnormal connections between the MMA and the sphenoparietal sinus, occasionally resulting from traumatic fractures of the skull or after extended craniotomies. 3,6,7,9,17 However, other authors have implied that the sphenoparietal sinus may represent an artificial combination of 2 venous structures-the parietal portion of the anterior branch of the middle meningeal veins and a dural channel located under the lesser sphenoid wing, the sinus of the lesser sphenoid wing. They suggested that the SMCV drains into the paracavernous sinus (laterocavernous sinus or the combination of the sphenobasal and sphenopetrosal sinuses) or the cavernous sinus rather than the venous structures described here in association with the lesser sphenoid wing.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Endovascular occlusion of these fistulous connections by transarterial or transvenous approaches is the primary therapeutic strategy for cure of these potentially dangerous lesions. Surgical disconnection of any recruited cortical draining veins may become necessary when embolization fails to eliminate the entire lesion.…”

Traumatic Middle Meningeal Artery and Fistula Formation with the Cavernous Sinus and a Review of the Literature on Endovascular Management of Traumatic Carotid Cavernous Fistulas

“…Many cases of middle meningeal fistula in association with head trauma were reported. [1][2][3][4][5][6][7][8][9][10][11][12] However, we are not aware of a reported case treated by detachable balloon and without skull fracture. In the present case, one month passed between head injury and the appearance of intracranial bruits.…”

“…A delayed onset of symptoms is mainly attributable to disruption of dural venous drainage and increased intracavernous pressure. [1][2][3]5,8] Neurosurgeons should be aware of this possibility that DAVF in the middle meningeal artery in patients without skull fracture. In our case, initially the common carotid angiography was performed [ Fig.2] and the lesion was misdiagnosed as Barrow Type A.…”

“…[1][2][3][4][5][6][7][8] This vascular lesion might be missed unless it exhibits clinical manifestations or are incidentally discovered during radiological examination such as magnetic resonance imaging or conventional angiography. [1][2][3][4][5][6][7][8] Here we present a case of traumatic middle meningeal artery, which subsequently established a fistula with the cavernous sinus. We also discuss the methods used for treatment of traumatic carotid cavernous fistulas [TCCFs].…”