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Fig 1. A, Right common carotid artery injection demonstrates massively enlarged inferolateral and meningohypophyseal trunks feeding a tentorial dural arteriovenous fistula (dAVF). This dAVF is also supplied by multiple external carotid artery (ECA) feeding vessels, including the petrous branch of the middle meningeal artery and the posterior division of the middle meningeal artery. The collecting pouch in the region of the tentorium drains into multiple cortical veins toward the midline to the deep venous fistula. Multiple cortical veins drain this fistula. The eventual emptying site is along the transverse sinus.
B, Right external carotid angiography demonstrates the course of the middle meningeal artery with supply to the fistula by the posterior division.
C, Right common carotid angiography demonstrates the microcatheter coursing through the posterior division of the middle meningeal artery with the tip in the venous pouch.
D, Right common carotid artery (CCA) injection after coil-embolization demonstrates no further fistula flow. Note course of microguidewire in the middle meningeal artery.
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