18. Traumatic Arterio-venous Fistula of the Middle Meningeal Vessels (A case report)

1965 Neurologia medico-chirurgica  
A rare case of the traumatic arterio-venous fistula involving the middle :meningeal vessels was reported, in which the middle meningeal veins were drained into the superior sagittal sinus. A 64-year-old male was wounded severely on the parietal region by a traffic accident, and was admitted to the OBATA surgical hospital on March 9, 1965. The common carotid arteriogram on the next day demonstrated this fistula as a tram track appearance of the vessels situated over the convexity of the skull,
more » ... ity of the skull, parallel to the middle meningeal groove. After 20 days, as he became apathetic and somewhat paraparetic, external carotid arteriography was carried out, in which enlargement of the fistula was showed with aneurysmic clubbing formed dilatation of the anterior branch of the vein. Craniotomy and resection of the affected dura was performed. Microscopical examination showed : dilatation of the artery and veins ; newly formed thrombus of vein ; thickened endothel especially on the veins ; and the disruption of the elastic fiber. Dural arterio-venous fistula was first reported by Fincher on 1951, only 8 cases including this case have been reported. The anatomical relation of the middle meningeal artery to the middle meningeal veins resembles to the relation of the internal carotid artery to the cavernous sinus, so this fistula is analogous to the carotid-cavernous fistula after head injury. Spontaneous closure happened in two reported cases. Operative treatments are as follows: (1) ligation of the external carotid artery; (2) intracranial ligation of the middle meningeal artery ; (3) resection of the dura including the fistula. The last operation is the most preferable for the -radical operation. -160-
doi:10.2176/nmc.7.160 fatcat:tv5rcifwtbckjda5pqtozh7gju