A CASE OF TRAUMATIC ACUTE EPIDURAL HEMATOMA WITH HEMORRHAGIC SHOCK COMPLICATED BY MIDDLE MENINGEAL ARTERIOVENOUS FISTULA AND CAROTID-CAVERNOUS SINUS FISTULA

Abstract

　　A 35-year-old man was admitted with a left temporal contusion, head and neck wounds, and hemorrhagic shock. The left external jugular vein and left superficial temporal artery were ligated promptly. Craniotomy was then performed to evacuate the acute epidural hematoma (AEDH) after the resolution of hemorrhagic shock. Arteriovenous fistula (AVF) was suspected on preoperative computed tomography. Selective cerebral angiography on day 2 revealed two AVFs : (1) from the left middle meningeal artery to the superficial middle cerebral and superior ophthalmic veins (middle meningeal arteriovenous fistula, MMAF), and (2) from a branch of the internal carotid artery to the cavernous sinus (carotid-cavernous sinus fistula, CCSF). On day 4, MMAF was treated with coil embolization, and CCSF was treated conservatively because of low risk of bleeding. Appropriate treatment of the head and neck wounds and AEDH, and the prompt diagnosis and treatment of the AVFs resulted in good patient outcomes.