Yabuki Masahiro, Akamatsu Yosuke, Kashimura Hiroshi, Kubo Yoshitaka, Ogasawara Kuniaki
1Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan; and.
2Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
J Neurosurg Case Lessons. 2023 Aug 7;6(6). doi: 10.3171/CASE23306.
Dural arteriovenous fistula (AVF) without cortical venous reflux (CVR) has a relatively benign course. Here, the authors describe a patient presenting with subdural hematoma due to a middle meningeal AVF without CVR.
A 17-year-old male was admitted to the emergency department with acute headache without an episode of head trauma. Computed tomography demonstrated a left acute subdural hematoma (SDH). Because the nontraumatic SDH raised the suspicion of vascular pathology, emergent angiography was performed, which demonstrated an AVF fed by the middle meningeal artery and draining to the diploic vein via the serpentine meningeal vein without CVR. T2-weighted magnetic resonance imaging (MRI) revealed no signs of venous congestion. Given the proximity of the AVF to the SDH and the MRI findings, we suspected that the serpentine meningeal vein was responsible for the SDH. The patient was successfully treated with transarterial Onyx embolization. During the injection, Onyx migrated to the extravascular space following its penetration into the serpentine meningeal vein, suggesting the meningeal vein was a bleeding source of the subdural hematoma.
Despite the absence of cortical venous reflux, serpentine meningeal venous drainage of middle meningeal AVF can be a source of subdural hemorrhage.
无皮质静脉回流（CVR）的硬脑膜动静脉瘘（AVF）病程相对良性。在此，作者描述了一名因无CVR的脑膜中动脉AVF导致硬膜下血肿的患者。
一名17岁男性因急性头痛被紧急送往急诊科，无头部外伤史。计算机断层扫描显示左侧急性硬膜下血肿（SDH）。由于非创伤性SDH引发了对血管病变的怀疑，遂进行了急诊血管造影，结果显示一个由脑膜中动脉供血、经蜿蜒的脑膜静脉引流至板障静脉且无CVR的AVF。T2加权磁共振成像（MRI）未显示静脉充血迹象。鉴于AVF与SDH的位置关系及MRI结果，我们怀疑蜿蜒的脑膜静脉是导致SDH的原因。该患者通过经动脉Onyx栓塞术成功治疗。注射过程中，Onyx进入蜿蜒的脑膜静脉后迁移至血管外间隙，提示脑膜静脉是硬膜下血肿的出血源。
尽管没有皮质静脉回流，但脑膜中动脉AVF的蜿蜒脑膜静脉引流可成为硬膜下出血的来源。
