Acquired Pial and Dural Arteriovenous Fistulae Draining into the Sylvian Veins after Craniotomy for Hematoma Evacuation: A Case Report

Abstract

We report a case of a 53-year-old man who presented with progressive left eye chemosis and proptosis 1 year after craniotomy for hematoma evacuation. Cerebral angiography showed a combination of dural and pial arteriovenous fistulas (AVF), which were supplied by the middle meningeal arteries (MMA) and the middle cerebral arteries and drained into the Sylvian veins (SSV) as the common venous drainage. Endovascular embolization of the MMA and surgical disconnection of the pial arteries were performed, and the shunt was successfully removed. These unique shunts were acquired after the previous surgery, and seemed to be associated. We hypothesized that the injury of the SSV during the evacuation of hematoma primarily induced the formation of dural AVF and that the hemodynamic changes brought about by the development of the dural AVF led to the formation of pial AVF secondarily.