Traumatic fistula between the middle meningeal artery and the sphenoparietal sinus

Claudia Unterhofer, Andreas Chemelli, Peter Waldenberger, Richard Bauer, Martin Ortler
Acta Neurochirurgica 2009, 151 (10): 1301-4

PURPOSE: Post-traumatic fistulas between the middle meningeal artery and the cranial venous system are extremely rare. We describe clinical presentation and successful endovascular management of a case of post-traumatic fistula between the middle meningeal artery and the sphenoparietal sinus.

METHODS: A 53-year-old man was admitted with multiple brain contusions and a temporoparietal fracture after a head trauma. On day 3 after trauma he developed unilateral signs of a cavernous sinus syndrome. Digital subtraction angiography showed a fistula between the middle meningeal artery and the sphenoparietal sinus.

RESULTS: The fistula was occluded by endovascular coil embolization, resulting in complete remission of the clinical symptoms.

CONCLUSION: A high index of suspicion is necessary to detect subtle signs of venous congestion of the cavernous sinus in an intubated patient. Angiography is the diagnostic modality of choice and should include the selective investigation of the external carotid artery vascular territory. Endovascular therapy provides minimal invasive and definitive treatment of this rare condition.

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