Background Traumatic arteriovenous fistulas (AVFs) involving the middle meningeal artery (MMA) mimicking a cavernous sinus fistula (CSF) are rare lesions that may develop after arterial injury to the MMA in proximity to a meningeal vein or dural sinus. The authors present the unusual case of an infant who sustained a minor head trauma after a short vertical fall.
Clinical history A 6-month-old girl initially presented with a bruit over the left temple. Symptoms progressed with increasing proptosis and enlarged conjunctival vessels on her left eye. Due to lacking clear evidence of a sufficient trauma in her history, an orbital tumor or vascular malformation were initially suspected. Magnetic resonance imaging (MRI) showed a left-sided enlarged middle meningeal artery (MMA) with filling of the cavernous sinus (CS) and superior ophthalmic vein (SOV) suggesting a cavernous sinus fistula (CSF). While conservative management was initially attempted, slowly progressing symptoms were observed during the following months and prompted endovascular treatment (EVT).
Procedure The right femoral artery was accessed using a 4F sheath and 4F diagnostic catheter. Right external carotid artery (ECA) injections revealed a single-channel high-flow AVF with connection between the left MMA and a short, irregular venous channel draining into the ipsilateral CS and dilated left SOV. A microcatheter was navigated to the initial segment of the fistulous connection and two detachable coils were deployed. Control runs after 20 minutes demonstrated complete occlusion of the fistula. The post procedural course was uneventful and the girl showed beginning clinical improvement after a few days with almost complete clinical recovery after 2 months. Follow-up MRI after seven weeks showed no signs of recurrence.
Summary Traumatic AVFs of the MMA mimicking a CSF in the pediatric population are extremely rare with this being the youngest reported case to date. Non-invasive vascular imaging and possible endovascular management should be considered early to prevent potential complications.
Disclosures R. Dahl: None. G. Roende: None. A. Born: None. G. Benndorf: None.
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