Surgical Treatment of a Sylvian-Middle Fossa Dural Arteriovenous Fistula Draining into the Basal Vein of Rosenthal with Frontotemporal Craniotomy

A 61-year-old man presented with left lower quadrianopsia caused by cerebral infarction in the right occpital lobe. Cerebral angiography revealed occlusion of right transverse sinus and Sylvian–middle fossa dural arteriovenous fistula (d-AVF) draining into the Sylvian vein and dilation of basal vein of Rosenthal. Surgical operation with right frontotemporal craniotomy was carried out to obliterate the fistula point and resection of the dura mater containing vasculature networks. Histologically, the thickening of walls of dural arteries and veins lacking internal elastica lamina were observed. Interestingly, the dura mater involving d-AVF was hyalinized and lacked collagen fibers, resembling local hypoxia and suggesting the possible role of dural hypoxia with pathogenesis of d-AVF. The present case  indicates that open surgery can be effective for Sylvian–middle fossa d-AVF for the purpose of obliteration of fistula point and resection of the dura for histopathologic analyses.