A rare complication of pediatric head injury
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LETTER TO THE EDITOR
A rare complication of pediatric head injury Ta-Chih Yu 1 & Wei Liu 2 & Ying-Ju Su 3 & Ying-Yi Lu 4,5,6 & Chieh-Hsin Wu 1,7 Received: 21 February 2020 / Accepted: 16 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, One unusual complication of skull fractures is traumatic fistula originating in the middle meningeal artery and resulting in fistulous communications between the artery and the neighboring veins or dural sinuses. Some fistulas resolve non-surgically, while others present symptomatically with headache, hemorrhage, or encephalopathy. This report describes a rare case of head injury resulting in a symptomatic fistula between the middle meningeal artery (MMA) and the sphenoparietal sinus. A 17-year-old male hospitalized after sustaining a head injury in a motor vehicle accident was diagnosed with skull fracture. He had no neurological signs other than headache and vertigo. Conservative treatment achieved a gradual improvement, and he was discharged after 1 week with no major neurological deficits. Three months later, he presented to a local hospital with frequent syncope, pulsatile tinnitus, and headache. A magnetic resonance imaging of the brain and angiography was performed under suspicion of vascular lesion. The patient was then referred to our hospital, where we performed a catheter angiography for a better characterization of the vascular malformation.
Right external carotid angiography revealed a middle meningeal arteriovenous fistula (AVF) draining into the superficial sylvian veins via the sphenoparietal sinus. Therefore, the patient was diagnosed with right middle meningealsphenoparietal sinus fistula (Figs. 1 and 2). Because this sphenoparietal dural arteriovenous fistula (DAVF) was symptomatic and had retrograde sinus flow with cortical venous drainage, endovascular surgery was performed to complete the fistula occlusion. Trans-arterial approach was performed by inserting an occlusion balloon microcatheter (Scepter C™, Microvention, Inc., Tustin, CA, USA) through the fistula opening on the sinus from the right MMA and then injecting routine dimethyl sulfoxide (DMSO) based Onyx 18 (EV3, Irvine-CA). A right carotid angiogram revealed complete obliteration of the fistula. The symptoms improved after the
* Chieh-Hsin Wu [email protected] 1
Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung 807, Taiwan
2
Department of Neurosurgery, Yucheng People’s Hospital, Shandong, People’s Republic of China
3
Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
4
Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
5
Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
6
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
7
Department of Surgery, School of Medicine, Coll
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