%0 Journal Article %A Amanda Baker %A Kunal Raygor %A M Travis Caton, Jr %A Kazim H Narsinh %A Eric Smith %A Christopher F Dowd %A Daniel L Cooke %A Randall T Higashida %A Matthew R Amans %A Adib A Abla %A Steven W Hetts %T Pharyngo-tympano-stapedial middle meningeal artery variant supply to a falcotentorial dural arteriovenous fistula %D 2022 %R 10.1136/neurintsurg-2022-018817 %J Journal of NeuroInterventional Surgery %P 1226-1228 %V 14 %N 12 %X 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. %U https://jnis.bmj.com/content/neurintsurg/14/12/1226.full.pdf