TY - JOUR T1 - Pharyngo-tympano-stapedial middle meningeal artery variant supply to a falcotentorial dural arteriovenous fistula JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/neurintsurg-2022-018817 SP - neurintsurg-2022-018817 AU - Amanda Baker AU - Kunal Raygor AU - M Travis Caton Jr AU - Kazim H Narsinh AU - Eric Smith AU - Christopher F Dowd AU - Daniel L Cooke AU - Randall T Higashida AU - Matthew R Amans AU - Adib A Abla AU - Steven W Hetts Y1 - 2022/05/11 UR - http://jnis.bmj.com/content/early/2022/05/11/neurintsurg-2022-018817.abstract N2 - 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. ER -