[A case of dural arteriovenous malformation in the anterior fossa]

Dural arteriovenous malformations (AVMs) are not uncommon. But most of dural AVMs are located in the cavernous portion or the transverse-sigmoid portion. Dural AVMs in the anterior fossa and very rare. We experienced a case of dural AVM in the anterior fossa and review 17 cases of dural AVM in the anterior fossa in the literature.

a 62-year-old male was admitted to our center because of unconsciousness and vomiting on Sept. 28; 1985. For nineteen months he had been on anticoagulant therapy after aorto-coronary bypass. Neurological examination on admission revealed somnolence and right-hemiparesis. CT scan revealed intracerebral hematoma in the left frontal lobe with ventricular perforation. Enhanced CT scan revealed patchy enhancement in the tip of the left frontal lobe. Selective angiographies were performed. Dural AVM, fed by both anterior ethmoidal arteries and drained by the cortical veins into the superior sagittal sinus and left superficial middle cerebral vein, was found. Selective external carotid angiography failed to visualize any AVM. MRI revealed spotty low signal intensity in the frontal tip by inversion recovery and spin echo. After admission his consciousness and right-hemiparesis improved completely. Left frontal craniotomy was done. On opening the dura, aneurysmal dilatation was found in the left frontal lobe, arising from the inner surface of the dura at the antero-medial corner of the left anterior fossa. From this aneurysmal dilatation a few veins entered the superior sagittal sinus. Red veins including aneurysmal dilation was removed from its origin together with the intracerebral hematoma. (ABSTRACT TRUNCATED AT 250 WORDS)