case_images: PMC8422413_01
case_images: (a and b) Axial and coronal noncontrast CT demonstrates a 7 mm right convexity mixed density subdural hematoma. (c and d) Anteroposterior and lateral projections, superselective catheter angiogram, and right middle meningeal artery frontoparietal branch injection demonstrating a right parietal dural arteriovenous fistula draining into the superior sagittal sinus.
case_images: SNI-12-438-g001.jpg
case_images: PMC8422413_01_SNI-12-438-g001.jpg
case_images: F1
case_images: Noncontrast head CT demonstrated a 7 mm right convexity mixed density subdural hematoma [Figures 1a and b]. Grade I DAVF [Figures 1c and d]. Given the absence of cortical venous reflux and benign natural history of the fistula, the remainder of the procedure did not deviate from routine MMA embolization.
case_images: PMC8422413_02
case_images: (a and b) Axial and coronal noncontrast CT demonstrates bilateral mixed density convexity subdural hematomas. (c and d) Anteroposterior and lateral views, superselective catheter angiogram, and right middle meningeal artery parietal branch injection demonstrating a dural arteriovenous fistula (DAVF) draining into an occipital cortical vein. (e and f) Oblique anteroposterior and lateral views, superselective catheter angiogram, and left middle meningeal artery temporal branch injection demonstrating a DAVF draining into vein of Labbe.
case_images: SNI-12-438-g002.jpg
case_images: PMC8422413_02_SNI-12-438-g002.jpg
case_images: F2
case_images: Noncontrast head CT demonstrated bilateral mixed density convexity subdural hematomas [22 mm on the left and 14 mm on the right; Figures 2a and b]. Grade III DAVFs, one arising from the parietal branch of the right MMA draining into an occipital cortical vein, and the second arising from the temporal branch of the left MMA draining into the vein of Labbe [Figures 2c-f]. Given the presence of cortical venous reflux and associated risk of future intracranial hemorrhage, treatment of the fistulae was indicated.
case_images: PMC8422413_03
case_images: (a) Axial noncontrast CT demonstrates 5 mm left convexity chronic subdural hematoma corresponding to the patient's initial presentation. (b) Axial noncontrast CT demonstrates interval increase in size of the left convexity subdural hematoma. (c and d) Axial and coronal noncontrast CT performed 1 month later demonstrates a new large right subacute on chronic subdural hematoma. (e and f) Anteroposterior and lateral views, selective catheter angiogram, and right common carotid artery injection demonstrating a cribriform plate dural arteriovenous fistula with ophthalmic artery feeders draining into a right frontal cortical vein.
case_images: SNI-12-438-g003.jpg
case_images: PMC8422413_03_SNI-12-438-g003.jpg
case_images: F3
case_images: Noncontrast head CT demonstrated a 5 mm left convexity CSDH [Figure 3a]. Noncontrast head CT demonstrated recurrence of the left convexity subdural hematoma [Figure 3b]. Surveillance CT demonstrated a new 27 mm right convexity mixed density subdural hematoma [Figures 3c and d]. Intraprocedural digital subtraction angiogram revealed a Cognard Grade III cribriform plate DAVF supplied by the right ophthalmic artery draining into a right frontal cortical vein [Figures 3e and f].