Dural Arteriovenous Malformation with Uncommon Draining Veins in the Anterior Fossa

Abstract

A case of dural arteriovenous malformation (AVM) in the anterior cranial fossa is reported. A 61-year-old male was hospitalized because of sudden onset of severe headache, vomiting, mild hemiparesis, and lethargy. Computerized tomography disclosed left frontal subcortical and frontotemporal subdural hematomas. Angiography revealed an AVM in the anterior cranial fossa, fed by the bilateral anterior ethmoidal arteries and drained by the left olfactory and left fronto-orbital veins. The latter veins had large, varicose dilatations and drained to the basal vein of Rosenthal. Two weeks after artificial embolization, surgical evacuation of the hematoma and removal of anomalous vessels, including a varicose dilated vein, were carried out. The involved dura at the olfactory groove was coagulated rather than totally removed. According to literature, the dural AVM in this region is fed primarily by the anterior ethmoidal artery and drains via the leptomeningeal veins into the superior sagittal sinus. Varicose dilatation of a draining vessel is considered a characteristic angiographical finding. The high incidence of bleeding from dural AVMs in this region is related to the varicose dilatation. The drainage capacity of the elongated leptomeningeal veins is insufficient, and the high arterial pressure in the AVM leads to the development of varicose dilatation and intracranial hemorrhage. © 1987, The Japan Neurosurgical Society. All rights reserved.