Traumatic Arteriovenous Fistula of the Middle Meningeal Artery During Infancy

Case Report and Review of the Literature
  • Rasmus Holmboe Dahl
  • Alfred Peter Born
  • Malene Landbo Børresen
  • Goetz BenndorfEmail author

Background and Importance

Traumatic arteriovenous fistulas (AVF) of the middle meningeal artery (MMA) are rare vascular lesions [1, 2]. After entering the middle cranial fossa through the foramen spinosum, the MMA courses laterally on the sphenoid bone in relation to an extensive network of variable small venous sinuses [3, 4]. This complex anatomy enables development of various traumatic MMA fistulas [2, 5, 6, 7, 8], but only three such cases involving the middle meningeal veins [9], pterygoid plexus [10], and sigmoid sinus [11] have been reported in pediatric patients. Fistulas of the MMA and carotid cavernous fistulas (CCF) [12, 13, 14, 15, 16, 17, 18, 19] constitute the majority of traumatic pediatric AVFs. They usually present months after the initial trauma. Traumatic MMA fistulas near the foramen spinosum may clinically mimic CCFs due to arterialization of the cavernous sinus (CS) [10]. Symptoms relate to orbital venous congestion causing bruit, proptosis, chemosis,...



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author Contribution

Conception and design: Dahl, Benndorf. Acquisition of data: R.H. Dahl, G. Benndorf. Analysis and interpretation of data: R.H. Dahl, G. Benndorf. Drafting the article: R.H. Dahl, G. Benndorf. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: G. Benndorf. Study supervision: G. Benndorf.

Compliance with ethical guidelines

Conflict of interest

R.H. Dahl, A.P. Born, M.L. Børresen and G. Benndorf declare that they have no competing interests.

Ethical standards

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. The patient’s parents consented to publication of the images and clinical information. Written informed consent was obtained.


  1. 1.
    Kitahara T, Shirai S, Owada T, Maki Y. Traumatic middle meningeal arteriovenous fistula. Report of 3 cases and analysis of 32 cases. Eur Neurol. 1977;16:136–43. CrossRefGoogle Scholar
  2. 2.
    Freckmann N, Sartor K, Herrmann HD. Traumatic arteriovenous fistulae of the middle meningeal artery and neighbouring veins or dural sinuses. Acta Neurochir (Wien). 1981;55:273–81. CrossRefGoogle Scholar
  3. 3.
    Shi ZS, Ziegler J, Feng L, Gonzalez NR, Tateshima S, Jahan R, Martin NA, Viñuela F, Duckwiler GR. Middle cranial fossa sphenoidal region dural arteriovenous fistulas: Anatomic and treatment considerations. AJNR Am J Neuroradiol. 2013;34:373–80. CrossRefGoogle Scholar
  4. 4.
    San Millán Ruíz D, Fasel JH, Rüfenacht DA, Gailloud P. The sphenoparietal sinus of breschet: Does it exist? An anatomic study. AJNR Am J Neuroradiol. 2004;25:112–20.Google Scholar
  5. 5.
    Unterhofer C, Chemelli A, Waldenberger P, Bauer R, Ortler M. Traumatic fistula between the middle meningeal artery and the sphenoparietal sinus. Acta Neurochir (Wien). 2009;151:1301–4. CrossRefGoogle Scholar
  6. 6.
    Smith JE, Epps J, Press HC Jr, Adair LB. Traumatic arteriovenous fistula between the middle meningeal artery and the sphenoparietal sinus: A case report and review of the world literature. J Natl Med Assoc. 1981;73:274–8.Google Scholar
  7. 7.
    Pakarinen S. Arteriovenous fistula between the middle meningeal artery and the sphenoparietal sinus. A case report. J Neurosurg. 1965;23:438–9. CrossRefGoogle Scholar
  8. 8.
    Sakata H, Nishimura S, Mino M, Hori E, Fujita T, Midorikawa H, Kaimori M, Nishijima M. Serial angiography of dynamic changes of traumatic middle meningeal arteriovenous fistula: Case report. Neurol Med Chir (Tokyo). 2009;49:462–4. CrossRefGoogle Scholar
  9. 9.
    Martinez M, Pergami P, Murnick J, Pearl MS. Embolization of a traumatic arteriovenous fistula between the middle meningeal artery and middle meningeal vein in a child with pulsatile tinnitus. Childs Nerv Syst. 2018;34:571–5.CrossRefGoogle Scholar
  10. 10.
    Yu J, Guo Y, Wu Z, Xu K. Traumatic arteriovenous fistula between the extracranial middle meningeal artery and the pterygoid plexus: A case report and literature review. Interv Neuroradiol. 2017;23:90–6. CrossRefGoogle Scholar
  11. 11.
    Vassilyadi M, Mehrotra N, Shamji MF, Michaud J. Pediatric traumatic dural arteriovenous fistula. Can J Neurol Sci. 2009;36:751–6. CrossRefGoogle Scholar
  12. 12.
    Brückmann H, Zeumer H, Meegen T, Kotlarek F. Orbital venous congestion in childhood. Diagnostic and therapeutical implications. Klin Padiatr. 1986;198:489–92. CrossRefGoogle Scholar
  13. 13.
    Pawar N, Ramakrishanan R, Maheshwari D, Ravindran M. Acute abducens nerve palsy as a presenting feature in carotid-cavernous fistula in a 6-year-old girl. GMS Ophthalmol Cases. 2013;3:Doc3. Google Scholar
  14. 14.
    Morais BA, Yamaki VN, Caldas JGMP, Paiva WS, Matushita H, Teixeira MJ. Post-traumatic carotid-cavernous fistula in a pediatric patient: A case-based literature review. Childs Nerv Syst. 2018;34:577–80. CrossRefGoogle Scholar
  15. 15.
    Yang Y, Kapasi M, Abdeen N, Dos Santos MP, O’Connor MD. Traumatic carotid cavernous fistula in a pediatric patient. Can J Ophthalmol. 2015;50:318–21. CrossRefGoogle Scholar
  16. 16.
    Souza MP, Willinsky RA, Terbrugge KG. Intracranial dural arteriovenous shunts in children. The Toronto experience. Interv Neuroradiol. 2003;9:47–52. CrossRefGoogle Scholar
  17. 17.
    Ciesielski T, Stefanowicz E, Brzozowski E. A case of post-traumatic carotid-cavernous fistula in a 9-year-old girl. Neurol Neurochir Pol. 1984;18:65–7.Google Scholar
  18. 18.
    Wajima D, Nakagawa I, Park HS, Yokoyama S, Wada T, Kichikawa K, Nakase H. Successful coil embolization of pediatric carotid cavernous fistula due to ruptured posttraumatic giant internal carotid artery aneurysm. World Neurosurg. 2017;98:871.e23-8. CrossRefGoogle Scholar
  19. 19.
    Arseni C, Horvath L, Ciurea V, Simionescu N. Carotid-cavernous fistula in the child. Neurol Psychiatr (Bucur). 1978;16:29–32.Google Scholar
  20. 20.
    Ellis JA, Goldstein H, Connolly ES, Meyers PM. Carotid-cavernous fistulas. Neurosurg Focus. 2012;32:E9. CrossRefGoogle Scholar
  21. 21.
    Tarantino CA, Dowd MD, Murdock TC. Short vertical falls in infants. Pediatr Emerg Care. 1999;15:5–8.CrossRefGoogle Scholar
  22. 22.
    Claudet I, Gurrera E, Honorat R, Rekhroukh H, Casasoprana A, Grouteau E. Home falls in infants before walking acquisition. Arch Pediatr. 2013;20:484–91. CrossRefGoogle Scholar
  23. 23.
    Betz H. Traumatic arteriovenous fistula between the middle meningeal artery and vein. Spontaneous regression trend during angiographic controls. Radiologe. 1974;14:528–31. Google Scholar
  24. 24.
    Benndorf G. Dural cavernous sinus fistulas: Diagnosis and endovascular therapy. Berlin Heidelberg: Springer; 2010.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyUniversity Hospital RigshospitaletCopenhagenDenmark
  2. 2.Department of PediatricUniversity Hospital RigshospitaletCopenhagenDenmark
  3. 3.Department of NeurologyUniversity Hospital AalborgAalborgDenmark
  4. 4.Department of RadiologyBaylor College of MedicineHoustonUSA

Personalised recommendations