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Dural arteriovenous fistula formation following bilateral middle meningeal artery embolization for the treatment of a chronic subdural hematoma: a case report

  • Case Report - Vascular Neurosurgery - Other
  • Published:
Acta Neurochirurgica Aims and scope

Abstract

Here is reported a case of dural arteriovenous fistula (DAVF) formation following middle meningeal artery (MMA) embolization. A 64-year-old male patient was operated for a bilateral CSDH by burr-hole craniostomy. Prophylactic post-operative MMA embolization was performed with 300–500-μm calibrated microparticles. The patient was admitted 3 months later for a left CSDH recurrence. Digital subtraction angiography demonstrated formation of a superior sagittal sinus DAVF fed by both superficial temporal arteries. This case highlights the possible role of local tissue hypoxia as a significant component of DAVF pathogenesis. Moreover, it has potential implications for MMA embolization as a management strategy for CSDH.

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Authors and Affiliations

  1. Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l’Hôpital, 75013, Paris, France

    Eimad Shotar, Kevin Premat, Eric Barberis, Atika Talbi, Stéphanie Lenck, Clara Cohen, Nader-Antoine Sourour & Frédéric Clarençon

  2. Sorbonne Université, Paris, France

    Kevin Premat, Vincent Degos, Bertrand Mathon & Frédéric Clarençon

  3. Department of Neurosurgical Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France

    Vincent Degos

  4. Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France

    Bertrand Mathon

Authors
  1. Eimad Shotar
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  2. Kevin Premat
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  3. Eric Barberis
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  4. Atika Talbi
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  5. Stéphanie Lenck
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  6. Clara Cohen
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  7. Vincent Degos
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  8. Nader-Antoine Sourour
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  9. Bertrand Mathon
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  10. Frédéric Clarençon
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Correspondence to Eimad Shotar.

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Comments

The authors report an interesting observation of a formation of a DAVF secondary to MMA embolization for treatment of a CSDH. This case deserves attention for two reasons:

1) Although not proven, local tissue hypoxia appears here the most likely explanation for the formation of the DAVF and may contribute to our general understanding of the pathogenesis in these lesions.

2) The potential development of a dural AV shunt following a benign procedure such as MMA embolization is, if observed more frequently, not trivial for the management of CSDH patients. More time and data should tell whether or not these aspects will gain clinical relevance. Systematic FU imaging in these patients should possibly be considered as small dural AV shunts can be clinically silent.

Goetz Benndorf,

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Shotar, E., Premat, K., Barberis, E. et al. Dural arteriovenous fistula formation following bilateral middle meningeal artery embolization for the treatment of a chronic subdural hematoma: a case report. Acta Neurochir 163, 1069–1073 (2021). https://doi.org/10.1007/s00701-020-04696-w

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  • DOI: https://doi.org/10.1007/s00701-020-04696-w

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