Dural arteriovenous malformations (AVM's) in the anterior fossa are not as rare as heretofore reported.
The authors experienced four cases of dural AVM in the anterior fossa over a period of 10 years: 3 of 4 patients had frontal intracerebral and/or subarachnoid hemorrhagic and one of them developed hemorrhagic attacks twice in a month. The other suffered from headache and chemosis without hemorrhage.
Angiographically, the AVM's were all fed by the anterior ethmoidal artery, either unilaterally or bilaterally; the external carotid system also sent the feeders. The draining veins were all pial with vascular sacs and finally reached the dural venous sinuses through ascending superficial and/or deep venous channels. One had an unruptured aneurysm at the origin of the ophthalmic artery.
All the AVM's were excised with microsurgery. The nidus was located in the dura or between the dura and bone. In one case, ethyl-cyanoacrylate was intraoperatively injected into the nidus from which uncontrollable bleeding developed, and the procedure is quite useful as operative adjuvant. All the patients have returned to their jobs.
Review of the pertinent literature reveals the following clinical characteristics:
1) AVM's are not so very rare,
2) 82% of the cases are male,
3) 89% of the cases have intracranial hemorrhages, a great majority of which are intracerebral and/or subarachnoid,
4) all are fed by the anterior ethmoidal arteries, with 46% incidence of contralateral feeding vessels,
5) the draining venous system includes the pial pathway in 100% of the cases, with association of vascular sacs (96%), which could be attributed to the source of hemorrhage, and
6) excision is the choice of treatment and operative results are good.
