Iatrogenic traumatic superficial temporal arteriovenous fistula development post-craniectomy: A case report

We report a case of superficial temporal arteriovenous fistula development following frontotemporoparietal hemicraniectomy. This patient presented with intracerebral hemorrhage (ICH) secondary to underlying arteriovenous malformation (AVM) rupture. Following decompressive hemicraniectomy and follow-up successful resection of the underlying AVM, the patient returned to the hospital with a seizure. Repeat angiography was performed, demonstrating no intracranial vascular lesion recurrence. However, an incidental superficial temporal arteriovenous fistula was identified, which was not visualized on initial angiography assessing the prior AVM. These lesions have been treated successfully in the past with surgical, endovascular, or combined approaches. As this patient was scheduled to undergo cranioplasty following AVM resection, the decision to occlude the fistula surgically was made. During cranioplasty, the fistula was identified as an engorged venous complex contiguous with the superficial temporal artery (STA) and was occluded. Follow-up angiography confirmed successful fistula occlusion and the patient has remained asymptomatic.