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Hemorrhagic stroke
Case report
Pharyngo-tympano-stapedial middle meningeal artery variant supply to a falcotentorial dural arteriovenous fistula
  1. Amanda Baker1,
  2. Kunal Raygor2,
  3. M Travis Caton Jr1,
  4. Kazim H Narsinh1,
  5. Eric Smith1,
  6. Christopher F Dowd1,
  7. Daniel L Cooke1,
  8. Randall T Higashida1,
  9. Matthew R Amans1,
  10. Adib A Abla2,
  11. Steven W Hetts1
  1. 1 Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
  2. 2 Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Amanda Baker, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA; amanda.baker{at}ucsf.edu

Abstract

The pharyngo-tympano-stapedial middle meningeal artery (PTS-MMA) variant has been described in one case report and never in the setting of arterial supply to a dural arteriovenous fistula, to our knowledge. We report the case of a middle-aged patient with severe, daily headache who presented to our institution for angiography and treatment. CT angiography and MRI demonstrated an enlarged left middle meningeal artery coursing to a large venous varix in the falcotentorial region. Dural arteriovenous fistula was confirmed by subsequent cerebral angiography. Endovascular treatment was performed but without complete obliteration of the fistula. Follow-up angiography demonstrated parasitized arterial supply from a right middle meningeal artery arising from the proximal cervical internal carotid artery coursing through the middle ear consistent with a PTS-MMA variant. The fistula was then treated surgically without recurrence at the 6-month follow-up.

  • Angiography
  • Fistula
  • Intervention
  • Liquid Embolic Material

https://doi.org/10.1136/neurintsurg-2022-018817

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    Footnotes

    • Twitter @amandaebaker, @EricRSmithMD

    • Contributors AB conceived the project idea. AB, KHN, MTC, and SWH completed the angiographic procedures with support from CFD and MRA. KR and AAA performed the surgery. AB and KR wrote the manuscript with support from TC, ES, KHN, DLC, RTH, CFD, MRA, AAA, and SWH.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.