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Dural arteriovenous malformations in the anterior cranial fossa
M K Başkaya1, Y Suzuki, Y Seki
1Department of Neurosurgery, Nagoya University School of Medicine, Japan.
Abstract:
Two cases of dural arteriovenous malformation (DAVM) fed by the anterior ethmoidal artery in the anterior cranial fossa are reported, one of them examined by magnet resonance imaging (MRI). Only one other case with MRI findings so far has been published. Fourty-eight previously reported cases are reviewed. One of our patients presented with subdural haematoma (SDH) without subarachnoid or intracerebral haemorrhage. The other patient had a nasal bleed without any neurological manifestations. In comparison with previously reported cases, the clinical manifestation of our cases is infrequent (1 patient with nasal bleed, and 2 patients with pure SDH that is 2 and 4%, respectively, in the literature). Feeder was the anterior ethmoidal artery either unilateral or bilateral. Drainage of DAVMs was through a markedly dilated vascular sac into the superior sagittal sinus (SSS). The high incidence of haemorrhage from DAVM in the anterior fossa is related to this vascular sac. Magnetic resonance imaging (MRI) showed a flow void area in the left frontal region on T 1-weighted images in one case. These cases were treated by surgical excision of the malformation with good results. Aetiology, clinical presentation, and treatment of these rare DAVMs in the anterior cranial fossa is discussed.
Insights
Rare dural arteriovenous malformations (DAVMs) in the anterior cranial fossa, fed by the anterior ethmoidal artery, present infrequently. Surgical excision yielded good results for these challenging cases.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Dural arteriovenous malformations (DAVMs) are rare vascular anomalies.
- DAVMs in the anterior cranial fossa are particularly uncommon.
- The anterior ethmoidal artery is an unusual feeder for cranial DAVMs.
Observation:
- Two cases of anterior cranial fossa DAVMs fed by the anterior ethmoidal artery are presented.
- One case featured subdural hematoma (SDH) without other intracranial hemorrhage.
- The second case presented with a nasal bleed, lacking neurological symptoms.
Findings:
- Anterior ethmoidal artery DAVMs can present with atypical symptoms like isolated SDH or epistaxis.
- Magnetic resonance imaging (MRI) can aid in diagnosing these rare lesions.
- Drainage via a dilated sac into the superior sagittal sinus may increase hemorrhage risk.
Implications:
- These findings highlight the diverse clinical presentations of anterior cranial fossa DAVMs.
- Early diagnosis and surgical management are crucial for favorable outcomes.
- Further research into the etiology and specific risk factors for these rare DAVMs is warranted.