A Case of Iatrogenic Middle Meningeal Arteriovenous Fistula That Occurred during Embolization of a Feeding Artery of Dural Arteriovenous Fistula

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Objective: A case of iatrogenic dural arteriovenous fistula that occurred during embolization of a feeding artery for transverse sinus (TS) dural arteriovenous fistula is reported.

Case Presentation: A 66-year-old woman suddenly noted pain of the left temporal region and nausea and was emergently transported to our hospital. CT of the head showed left subcortical hemorrhage, and DSA demonstrated a dural arteriovenous fistula at the left TS. Although embolization of the feeding artery was attempted via the middle meningeal artery (MMA), a middle meningeal arteriovenous fistula (MMAVF) developed as the MMA was damaged by intraoperative balloon inflation. The MMA was immediately embolized together with the fistulous opening using n-butyl-2-cyanoacrylate (NBCA) and coils, and no sequelae were observed postoperatively.

Conclusion: We experienced dural arteriovenous fistula caused by injury of the feeding artery during endovascular treatment. It must be remembered that iatrogenic arteriovenous fistula is a complication of endovascular treatment that is rare but requires attention.