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Case Reports
. 2021 Apr;27(2):281-284.
doi: 10.1177/1591019920960248. Epub 2020 Sep 20.

Idiopathic middle meningeal artery and middle meningeal vein fistula presenting as temporal intraparenchymal hemorrhage

Daisuke Sato  1 , Hiroshi Saito  1 , Takeya Suzuki  1 , Takahiro Ota  1
Affiliations
Case Reports

Idiopathic middle meningeal artery and middle meningeal vein fistula presenting as temporal intraparenchymal hemorrhage

Daisuke Sato et al. Interv Neuroradiol. 2021 Apr.

Abstract

Middle meningeal artery (MMA) and middle meningeal vein (MMV) fistula is a rare lesion. Hemorrhagic propensity for this pathology has not been widely recognized. We encountered a case of idiopathic MMA-MMV fistula presenting as intracerebral hemorrhage. MMA and MMV showed a single fistula and the enlarged MMV coiled around the MMA, resembling a varix. We treated the case using endovascular techniques. This case highlights the anatomy along the course of the MMV and is unique, since no backward leptomeningeal drainage was observed. A bone defect in the meningeal groove on computed tomography and a "green caviar appearance" on angiography may be characteristic of this rare pathology.

Keywords: MM-AVF; MMA-MMV fistula; intraparenchymal hemorrhage; transarterial embolization.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a, b) CT scan demonstrated a left temporal subcortical hemorrhage, which was up to 45mm in size. (c) The hematoma was adjacent to the meningeal groove (arrow) and continued to the foramen spinosum. (d) The left meningeal groove nearby the foramen spinosum (arrow) was eroded and unusually enlarged (contrast enhanced CT). CT: computed tomography.
Figure 2.
Figure 2.
(a, b) Angiography demonstrated the presence of an AVF (arrow) involving the MMA and MMV (a, AP view; b, lateral view). (c,d) The drainage route from this fistula was mainly into the pterygoid plexus, and no cortical venous or sinus reflux were observed in the venous phase (c, AP view; d, lateral view). (e) Photograph of green caviar. (f, g) SWI revealed no signs of venous congestion. AP: antero-posterior; AVF: arterio-venous fistula; SWI: susceptibility weighted imaging; MMA: middle meningeal artery; MMV: middle meningeal vein.
Figure 3.
Figure 3.
(a) The fistulous hole between the MMA and MMV was single (arrow). (b) We embolized the MMA with detachable coils from the distal of the exact fistula point, and injected 20% n-butyl-2-cyanoacrylate from the exact fistula point to the proximal portion. (c, d) Complete occlusion of the fistula was obtained, and the abnormal blood flow toward the MMV vanished (c, AP view; d, lateral view) AP: antero-posterior; MMA: middle meningeal artery; MMV: middle meningeal vein.
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