Spontaneous arteriovenous fistula of the superficial temporal artery: Diagnosis and treatment.

OBJECTIVES: Despite the increasing reports of traumatic and iatrogenic arteriovenous fistulas (AVFs) of the superficial temporal artery (STA), the spontaneous origination of fistulas is extremely rare, and very little is known about their natural development. Spontaneous AVFs of the STA have the characteristic findings of an expanding, painless pulsatile mass and a palpable thrill with or without a vascular murmur.

PATIENTS AND METHODS: This article describes five patients with AVFs of the STA with no history of a head injury. Four of them were treated successfully either by surgical resection or by endovascular embolization. These five illustrative cases with their medium-term follow-up results are reported.

RESULTS: In two patients, we successfully used a single-balloon alone to occlude the fistula without any complications; the patients experienced no recurrences during the clinical follow-up. In the other two patients, we carefully identified and ligated all of the involved feeding arteries and draining veins, which was followed by an excision of the lesion. At the 6-month follow-up, the patients were doing very well, with no evidence of AVF recurrences or new neurological complaints.

CONCLUSIONS: AVFs of the STA can be detected via a computed tomography angiogram (CTA) or by intra-arterial angiography alone. Intra-arterial angiography, however, remains the definitive type of investigation. AVF may be treated either by surgical ligation and excision under a local or general anesthetic or by endovascular embolization. The former modality has been the most common method of treating the lesion in the vast majority of reports. However, endovascular embolization also appears to be suitable for treating this condition.