PMC8247668_01
Initial head CT after trauma 7 years before AV fistula development. (a) L temporal epidural hematoma with 0.5 cm midline shift. (b) Postoperative CT scan demonstrating evacuation of EDH and improvement of midline shift.
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F1
He had a history of trauma 7 years prior resulting in a left 2.5 cm temporal epidural hematoma [Figure 1a] which required evacuation [Figure 1b] and a left posterior petrous temporal bone fracture.
Engorged left temporal vessels 7 years following traumatic epidural hematoma evacuation. (a and b) Clinical presentation of the left anterolateral scalp swelling. (c and d) CTA head 7 years after initial trauma demonstrated scalp engorged vessels.
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F2
A tortuous vein was seen over the lateral aspect of the left eyebrow [Figure 2a and b]. A computed tomography angiography (CTA) of the head was obtained that demonstrated numerous dilated scalp veins overlaying the temporalis muscle and extending into the face [Figure 2c and d].
Pre- and post-embolization angiogram. (a, b, c) AP, lateral, and selective internal maxillary angiogram demonstrating the deep temporal arterial feeders, venous pouch, and venous drainage. (d, e, f) Postoperative angiogram demonstrating obliteration of the AV fistula after embolization.
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F3
There was no evidence of intracranial venous drainage but there was significant hypertrophy of the deep temporal arteries supplying the fistula to a large venous pouch on the patient's scalp [Figure 3]. Follow-up angiogram showed no residual filling of the fistula [Figure 3].
Six-month follow-up angiogram. (a) Lateral image of the left ICA. (b) AP image of the left internal maxillary artery (IMA). (c) Oblique view of IMA.
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F4
A 6-month postoperative angiogram was performed that demonstrated successful obliteration of the scalp AV fistula [Figure 4].