Anatomical variations identified at the skull base can result in challenges to the clinician. For example, the anatomy of the foramen ovale and its neighboring structures is critical knowledge for the surgeon who performs transcutaneous approaches to the foramen ovale for treating patients with trigeminal neuralgia. One nearby structure that can compound invasive procedures and potentially result in complications is the foramen of Vesalius. Although usually small, we report a giant foramen of Vesalius found in an adult female skull. The anatomy and clinical aspects of such a finding are discussed and related to other reports in the literature.

Dural arteriovenous fistulas (dAVFs) are commonly encountered by the neurosurgeon. Herein, we present a case illustration of an infant presenting with an extremely large fistula that took up a significant part of the intracranial volume. A one-month-old female presented with irritability and failure to thrive. She was the product of a 35-week pregnancy and was delivered vaginally without complications or a difficult labor. Based on the findings of magnetic resonance imaging, the diagnosis of a giant dAVF involving the transerve-sigmoid sinuses was made. The patient was scheduled for an arteriogram but died before the procedure could be performed. Such a case illustrates how large some dAVF can become and at a very early age. As in the present case, the patient was minimally symptomatic. Therefore, the time to intervention after diagnosis is thus, sometimes, critical.