Dural Arteriovenous Fistula of the Sinus of the Lesser Sphenoid Wing Presenting with Pontine Hemorrhage.

Abstract

Dural arteriovenous fistulas (DAVFs) of the sinus of the lesser sphenoid wing (SLSW) with leptomeningeal drainage are rare. We report a patient with a DAVF of the SLSW draining into the basal vein of Rosenthal (BVR) presenting with pontine hemorrhage. A 71-year-old man presented with sudden right hemisensory disturbance of the arm and leg. Brain computed tomography scan showed left pontine hemorrhage, and cerebral angiography revealed a DAVF of the left SLSW. The fistula drained solely into the left BVR, which had an anastomosis to the left lateral mesencephalic vein, which had a varix invaginated into the left pons. The diagnosis was a DAVF of the left SLSW drained into the lateral mesencephalic vein via the bridging vein of the left SLSW, the deep middle cerebral vein, and the BVR, and a varix of the lateral mesencephalic vein caused pontine hemorrhage. The fistula was occluded by clipping through frontotemporal craniotomy. The postoperative course was uneventful, and postoperative cerebral angiography confirmed disappearance of the fistula. A DAVF of the SLSW presenting with pontine hemorrhage is extremely rare, and DAVFs with deep leptomeningeal drainage should be included among a variety of etiologies of pontine hemorrhage.