Acquired dural arteriovenous fistula after subdural evacuation port system placement: A case report

The subdural evacuation port system (SEPS) is a rapid, bedside, and less invasive option for subdural hemorrhage management. Proper procedure planning and understanding of the relevant vascular anatomy is important for minimizing complications and future procedures.

We describe a case where following placement of a SEPS, there was immediate development of a new dural arteriovenous fistula (dAVF) between the middle meningeal artery (MMA) and middle meningeal vein. Angiography confirmed site of shunting to be at the proximity of the twist drill hole placement. Subsequent MMA embolization was performed and follow-up MRI confirmed resolution of the dAVF.

SEPS-associated dAVF is an underreported complication with potential long-term consequences. This case describes the complication and advocates avoiding SEPS anterior to the coronal suture.