Abstract 1122‐000177: Dural Arteriovenous Fistulas with Traumatic Subdural Hematomas: A Case Series

Abstract

Introduction : Dural arteriovenous fistula (dAVF) is a pathological shunt between the dural arterial supply and venous system including cortical veins and/or venous sinuses. Middle meningeal artery (MMA) embolization as an indication for chronic subdural hematomas (SDH) treatment has been evolving over the past few years. The relationship between traumatic SDH and dAVF is not well established. Methods : Twenty‐one consecutive patients who received MMA embolization for chronic SDH performed in a single center from July 2020 to June 2021 were reviewed. We report a series of four cases of dAVF discovered immediately before or during MMA embolization for chronic SDH secondary to trauma. Results : 15/21 (71%) patients were traumatic SDH. 4/15 (27%) of the patients were found to have dAVF on cerebral angiography immediately before or during MMA embolization. In two patients, the dAVF was demonstrated via super‐selective microcatheter angiography of the external carotid and middle meningeal artery prior to embolization. The two patients, dAVF developed via the MMA distal to catheter placement during embolizing agent administration. These latter fistulae were uncovered due to the change of vascular resistance to surrounding meningeal branches. All four fistulae were successfully obliterated. Conclusions : Our case series demonstrate that traumatic SDH can be associated with dAVF. These fistulae may be associated with persistent SDH collections or refractory reaccumulations. While the true incidence and natural history of dAVF associated with traumatic SDH is unknown, we posit that cerebral angiography may be a necessary component in the complete evaluation of traumatic SDH.