Surgical Treatment of Anterior Cranial Fossa Dural Arteriovenous Fistula - Report of Two Cases

Abstract

Anterior cranial fossa dural arteriovenous fistula (DAVF) is uncommon. In this report, we present two patients with anterior cranial fossa DAVF. The first patient was a 46-year-old man who had had two episodes of generalized tonic-clonic seizure. Magnetic resonance imaging revealed abnormal vasculature in the right anterior frontal area and bilateral carotid angiogram demonstrated a DAVF in the right anterior cranial fossa. The feeding arteries were from the bilateral anterior ethmoid arteries, middle meningeal arteries, and superficial temporal arteries. The venous drainage was through the cortical veins of the right frontal lobe and then the superior sagittal sinus. Venous ectasia was also noted. During surgery, the feeding arteries from the external carotid artery were divided and the leptomeningeal draining veins were interrupted without excision of the nidus. Angiography one year after surgery revealed no residual DAVF. The patient was doing well after five years of follow-up except for one episode of seizure. The other patient was a 62-year-old man who suffered sudden onset of severe headache with vomiting and consciousness disturbance. Brain computed tomography (CT) scanning revealed intracerebral hemorrhage in the right frontal lobe. A CT angiogram showed abnormal vasculature and a carotid angiogram demonstrated an anterior cranial fossa DAVF with a feeding artery from the right anterior ethmoid artery. The venous drainage was through a cortical draining vein in the right frontal lobe and finally the superior sagittal sinus. Venous ectasia was also noted. The patient underwent surgery to remove the intracerebral hematoma and excise the DAVF. Post-operative angiography showed no residual DAVF. The patient was in good condition after one and one half years of follow-up. (Tzu Chi Med J 2003; 15:199-204)