PMC9945360_01
(a) AP view of time-of-flight magnetic resonance angiography showed a dilated vessel from the branch of external carotid artery (ECA) (yellow arrow). (b) The lateral angiographic view of the left ECA shows a dural fistula with primary feeding from the accessory branch of the meningeal artery (yellow arrow). (c) Superselective microcatheter injection of accessories meningeal artery. (d) Late anterograde venous flow to inferior petrosal sinus.
JNRP-14-140-g001.jpg
PMC9945360_01_JNRP-14-140-g001.jpg
F1
MRI showed no abnormalities, yet time-of-flight MRA (TOFMRA) showed a dilated vessel from the left external carotid artery (ECA) branch on the left temporal region [Figure 1a]. Type I dural fistula in the left middle cranial fossa with a feeder from the internal maxillary artery through the accessories branch of the meningeal artery, with venous ectasia with a size of 4.8 mm x 8.2 mm [Figure 1b and 1c]. The diagnosis of DAVF, fed by the left ECA and draining into the left inferior petrosal sinus [Figure 1d], was therefore made.
Transarterial curative embolization. (a) The microcatheter was positioned as close as dural arteriovenous fistula, the tip of the microcatheter (yellow arrow). (b) N-butyl-2-cyanoacrylate and iodized oil (Lipiodol) with concentration 1:1 50% were injected through the microcatheter to embolize the fistulous point (yellow arrow). (c) Post-embolization showed no more fistula (circle) and patent flow of the artery branches.
JNRP-14-140-g002.jpg
PMC9945360_01_JNRP-14-140-g002.jpg
F2
The Magic microcatheter 1.5-F was positioned as close as DAVF [Figure 2a]. N-butyl-2-cyanoacrylate (n-BCA) and iodized oil (Lipiodol) with a concentration of 1:1 50% were chosen as liquid embolic agents because it was a slow-flow DAVF [Figure 2b]. Post-embolization angiogram showed no more fistula and patent flow of the artery branches [Figure 2c].