A case of vertex epidural hematoma (VEDH) as a manifestation of dural arteriovenous fistula in the superior sagittal sinus (SSS-dAVF) with no history of head trauma

Abstract

We experienced a case of vertex epidural hematoma (VEDH) as a manifestation of dural arteriovenous fistula in the superior sagittal sinus (SSS-dAVF) with no history of head trauma, successfully treated with endovascular surgery. A 28-year-old male presented to our department with headache; emergent head CT scans revealed acute VEDH. He had no history of trauma. Cerebral angiography showed SSS-dAVF, and he was diagnosed with secondary VEDH by the rupture of SSS-dAVF. The feeder of this dAVF was the middle meningeal artery. The patient was treated conservatively in the acute phase. However, to prevent rebleeding of the dAVF, we decided to perform endovascular treatment (transarterial embolization) for it at the subacute phase of the VEDH. Endovascular treatment eliminated the shunt flow, and his postoperative course was excellent. To our knowledge, this is the first report of the VEDH caused by the rupture of SSS-dAVF without history of head trauma. Cerebral angiography is especially helpful for accurate diagnosis of VEDH with no history of trauma. In cases of VEDH caused by the rupture of SSS-dAVF, endovascular treatment is a safe and effective treatment option for eliminating shunt lesions.