PMC10101702_01
MRA on the admission day.
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Left MMA was dilated (arrow) and meningeal veins (arrowhead) around it were seen on MRA.
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MRI shows a relatively dilated middle meningeal artery (MMA) with surrounding dilated veins was admitted, and we suspected an existence of AV shunt (Fig. 1).
DSA.
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2 (a, b); Left ECAG revealed MMAVF.
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2 (c, d); The drainer of the shunt ran into the venous plexus around the mandibular joint, which we thought caused mandibular joint pain.
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The main drainage route started from the MMV, went through an emissary vein of the temporal bone, and ran into the venous plexus around the mandibular joint (Fig. 2).
Working angle.
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3 (a); MMA had an AV shunt at a proximal point of the convexity branch (arrow). Meningeal veins (arrowhead) made a hairpin curve, and they were directed into an emissary vein and venous plexus around the mandibular joint.
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3 (b); At the shunt point, there was an aneurysmal dilatation of MMA (double arrow).
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3 (c); i-ED coils were placed on the shunt point, a part of MMA, and meningeal veins.
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CT revealed a single shunt point with an aneurysm-like arterial dilatation at the shunt (Fig. 3). Considering it as a symptomatic MMAVF case, the fistula was embolized.
DSA after coiling.
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4 (a, b); Left ECAG showed vanishment of the MMAVF.
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The blood flow through the shunt point vanished, and we finished the treatment (Fig. 4).