Middle meningeal arteriovenous fistulas: A rare and potentially high-risk dural arteriovenous fistula

Abstract

Background:Middle meningeal arteriovenous fistulas (MMAVFs) are rare lesions with a poorly established natural history. We report our experience with patients with MMAVFs who presented with intracranial hemorrhage.Methods:We reviewed our prospectively maintained endovascular database for patients with MMAVFs, who were treated by embolization during a 15-year period. Hospital and outpatient medical records and imaging studies were reviewed.Results:Nine patients with MMAVFs, who presented with intracranial hemorrhage, underwent embolization (mean age 60.3 years, range 21–76; four male and five female). Four patients presented after trauma and five after spontaneous hemorrhage. All nine patients were angiographically cured after embolization of the fistula with liquid embolic agents (n = 8) or coils (n = 1). There were no procedure-related complications.Conclusion:MMAVFs represent a rarely reported class of vascular lesions. They are typically associated with trauma, but also develop spontaneously, and may be associated with intracranial hemorrhage, which warrants classification of these lesions as high risk. Endovascular treatment is safe and effective and should be considered for these patients, particularly for those who have lesions with intracranial venous drainage.

Two Cases of Idiopathic Middle Meningeal Arteriovenous Fistula Initially Diagnosed by Magnetic Resonance Angiography

“…Therefore, it has been reported that the vessel wall injury of MMA caused by head trauma, craniotomy [ 10 ], or interventional surgery [ 7 , 8 ] can cause MMAVF. However, there are a few reports of idiopathic MMAVF with no history of head trauma, craniotomy, or interventional surgery [ 4 , 12 ]. In these reports, all cases presented with intracranial haemorrhage.…”

“…There are rare reports of MMAVF spontaneously disappearing [ 11 , 12 ]. On the other hand, Rami et al [ 4 ] reported nine cases of MMAVF, which were all caused by intracranial haemorrhage, and mentioned that both traumatic and idiopathic MMAVF should be considered high-risk lesions that require treatment. Additionally, Kitahara et al [ 6 ] reported a case of cavernous sinus syndrome that occurred by the drainage root of MMAVF.…”

“…It is thought that MMAVF was treated successfully through early treatment. In recent reports [ 2 - 4 , 6 - 8 ], good obstructions of MMAVF were achieved by embolisation with endovascular treatment, although the embolic materials were different, such as polyvinyl alcohol [ 7 ], coil [ 4 , 6 ], n-butyl-2-cyanoacrylate (NBCA) [ 4 ], coil + NBCA [ 8 ], Onyx [ 4 ], and coil + Onyx [ 2 ]. In this report, positive results were obtained by coil embolisation with endovascular treatment from MMV to MMA through a shunt point.…”

“…Most middle meningeal arteriovenous fistula (MMAVF) cases are post-traumatic MMAVF [ 1 - 6 ] and sometimes are iatrogenic MMAVF [ 7 - 11 ]. Reports of idiopathic MMAVF are extremely rare [ 4 , 12 ]. On the other hand, MMAVF diagnoses are typically confirmed by cerebral angiography, a relatively invasive examination.…”

Spontaneous Middle Meningeal Arteriovenous Fistula Caused by Aneurysm Rupture: A Case Report

“…Although there are many reports of traumatic or iatrogenic MMAVF cases, only nine spontaneous cases reported in English translation have been found (Term; "middle meningeal arteriovenous fistula" or "middle meningeal artery fistula"). 1,2,[9][10][11] We summarize those characteristics in Supplementary Tables 1 and 2.…”