Spontaneous and simultaneous bilateral middle meningeal arteriovenous fistula: A case report
10.7461/jcen.2025.E2024.04.001
- Author:
Gi-Yong YUN
;
Jae-Min AHN
;
Jong-Hyun PARK
;
Hyuk-Jin OH
;
Jai-Joon SHIM
;
Seok-Mann YOON
- Publication Type:Case Report
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2026;28(1):49-56
- CountryRepublic of Korea
- Language:English
-
Abstract:
Middle meningeal arteriovenous fistulas (MMAVFs) are known as rare diseases, often associated with head trauma, with idiopathic cases being exceedingly uncommon. Here, we present a clinical case of spontaneous and simultaneous bilateral MMAVFs in a 37-year-old woman. She presented with persistent pulsatile tinnitus but no history of head trauma. Bilateral MMAVFs were identified via Time-of-Flight Magnetic Resonance Angiography. Subsequent digital subtraction angiography revealed a fistula between the middle meningeal artery (MMA) and middle meningeal vein (MMV) without definite intracranial venous reflux. We had planned coil embolization via a trans-arterial approach for both sides. Remarkably, after six days, the right-sided MMAVF observed in the previous external carotid artery (ECA) angiogram disappeared spontaneously. The left-sided MMAVF was successfully treated with coil embolization, achieving complete obliteration of fistula flow. Postoperatively, the patient’s pulsatile tinnitus disappeared, and she was discharged without medication. There are a few possible mechanisms of spontaneous MMAVFs, such as middle meningeal artery aneurysm and trivial head trauma. Trans-arterial embolization with coils appears to be an effective and safe treatment option for complete obliteration of fistula flow.
