{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T14:11:45Z","timestamp":1774879905296,"version":"3.50.1"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T00:00:00Z","timestamp":1691366400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Dural arteriovenous fistula (AVF) without cortical venous reflux (CVR) has a relatively benign course. Here, the authors describe a patient presenting with subdural hematoma due to a middle meningeal AVF without CVR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 17-year-old male was admitted to the emergency department with acute headache without an episode of head trauma. Computed tomography demonstrated a left acute subdural hematoma (SDH). Because the nontraumatic SDH raised the suspicion of vascular pathology, emergent angiography was performed, which demonstrated an AVF fed by the middle meningeal artery and draining to the diploic vein via the serpentine meningeal vein without CVR. T2-weighted magnetic resonance imaging (MRI) revealed no signs of venous congestion. Given the proximity of the AVF to the SDH and the MRI findings, we suspected that the serpentine meningeal vein was responsible for the SDH. The patient was successfully treated with transarterial Onyx embolization. During the injection, Onyx migrated to the extravascular space following its penetration into the serpentine meningeal vein, suggesting the meningeal vein was a bleeding source of the subdural hematoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Despite the absence of cortical venous reflux, serpentine meningeal venous drainage of middle meningeal AVF can be a source of subdural hemorrhage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23306","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T10:10:44Z","timestamp":1691489444000},"source":"Crossref","is-referenced-by-count":1,"title":["Spontaneous middle meningeal arteriovenous fistula without cortical venous reflux presenting with acute subdural hematoma: illustrative case"],"prefix":"10.3171","volume":"6","author":[{"given":"Masahiro","family":"Yabuki","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosuke","family":"Akamatsu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan; and"},{"name":"Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Kashimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshitaka","family":"Kubo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuniaki","family":"Ogasawara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Radiology","first-page":"671","article-title":"Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage","volume":"194","author":"Cognard C","year":"1995","unstructured":"Cognard C, Gobin YP, Pierot L,  Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995;194(3):671\u2013680.7862961"},{"issue":"2","key":"b2","series-title":"J Neurosurg","first-page":"166","article-title":"A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment","volume":"82","author":"Borden JA","year":"1995","unstructured":"Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg. 1995;82(2):166\u2013179.7815143"},{"issue":"5","key":"b3","series-title":"J Neurosurg","first-page":"830","article-title":"The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas","volume":"85","author":"Davies MA","year":"1996","unstructured":"Davies MA, TerBrugge K, Willinsky R, Coyne T, Saleh J, Wallace MC. The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg. 1996;85(5):830\u2013837.8893721"},{"issue":"5","key":"b4","series-title":"Acta Neurochir Suppl (Wien)","first-page":"123","article-title":"Hemodynamic status and treatment of aggressive dural arteriovenous fistulas","volume":"94","author":"Kuwayama N","year":"2005","unstructured":"Kuwayama N, Kubo M, Tsumura K, Yamamoto H, Endo S. Hemodynamic status and treatment of aggressive dural arteriovenous fistulas. Acta Neurochir Suppl (Wien). 2005;94(5):123\u2013126."},{"issue":"2","key":"b5","series-title":"Interv Neuroradiol","first-page":"173","article-title":"Middle meningeal arteriovenous fistula and its spontaneous closure. A case report and review of the literature","volume":"13","author":"Chandrashekar HS","year":"2007","unstructured":"Chandrashekar HS, Nagarajan K, Srikanth SG, Jayakumar PN, Vasudev MK, Pandey P. Middle meningeal arteriovenous fistula and its spontaneous closure. A case report and review of the literature. 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Acta Neurol Belg. 2010;110(2):190\u2013192.20873450"},{"issue":"6","key":"b10","series-title":"Neurosurgery","first-page":"E1750","article-title":"Delayed presentation of traumatic cerebral and dural arteriovenous fistulae after a BB gun accident in a pediatric patient: case report","volume":"68","author":"Abla AA","year":"2011","unstructured":"Abla AA, Albuquerque FC, Theodore N, Spetzler RF. Delayed presentation of traumatic cerebral and dural arteriovenous fistulae after a BB gun accident in a pediatric patient: case report. Neurosurgery. 2011;68(6):E1750\u2013E1754, discussion E1754\u2013E1755."},{"issue":"9","key":"b11","series-title":"Surg Neurol Int","first-page":"S219","article-title":"Middle meningeal arteriovenous fistulas: A rare and potentially high-risk dural arteriovenous fistula","volume":"7","author":"Almefty RO","year":"2016","unstructured":"Almefty RO, Kalani MY, Ducruet AF, Crowley RW, McDougall CG, Albuquerque FC. 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Acta Neurochir Suppl (Wien). 2005;94(5):123\u2013126."},{"issue":"2","key":"b5","series-title":"Interv Neuroradiol","first-page":"173","article-title":"Middle meningeal arteriovenous fistula and its spontaneous closure. A case report and review of the literature","volume":"13","author":"Chandrashekar HS","year":"2007","unstructured":"Chandrashekar HS, Nagarajan K, Srikanth SG, Jayakumar PN, Vasudev MK, Pandey P. Middle meningeal arteriovenous fistula and its spontaneous closure. A case report and review of the literature. Interv Neuroradiol. 2007;13(2):173\u2013178.20566146"},{"issue":"6","key":"b6","series-title":"Surg Neurol","first-page":"460","article-title":"Intracerebral hemorrhage from a middle meningeal arteriovenous fistula with a giant venous varix","volume":"37","author":"Pritz MB","year":"1992","unstructured":"Pritz MB, Pribram HF. Intracerebral hemorrhage from a middle meningeal arteriovenous fistula with a giant venous varix. Surg Neurol. 1992;37(6):460\u2013463.1595052"},{"issue":"1","key":"b7","series-title":"Minim Invasive Neurosurg","first-page":"36","article-title":"Dural arteriovenous fistula presenting as an acute subdural hemorrhage that subsequently progressed to a chronic subdural hemorrhage: case report","volume":"52","author":"Kohyama S","year":"2009","unstructured":"Kohyama S, Ishihara S, Yamane F, Kanazawa R, Ishihara H. Dural arteriovenous fistula presenting as an acute subdural hemorrhage that subsequently progressed to a chronic subdural hemorrhage: case report. Minim Invasive Neurosurg. 2009;52(1):36\u201338.19247903"},{"issue":"10","key":"b8","series-title":"Neurol Med Chir (Tokyo)","first-page":"462","article-title":"Serial angiography of dynamic changes of traumatic middle meningeal arteriovenous fistula: case report","volume":"49","author":"Sakata H","year":"2009","unstructured":"Sakata H, Nishimura S, Mino M,  Serial angiography of dynamic changes of traumatic middle meningeal arteriovenous fistula: case report. Neurol Med Chir (Tokyo). 2009;49(10):462\u2013464.19855142"},{"issue":"2","key":"b9","series-title":"Acta Neurol Belg","first-page":"190","article-title":"Dural arteriovenous fistula on the convexity presenting with pure acute subdural hematoma","volume":"110","author":"Ogawa K","year":"2010","unstructured":"Ogawa K, Oishi M, Mizutani T, Maejima S, Mori T. Dural arteriovenous fistula on the convexity presenting with pure acute subdural hematoma. Acta Neurol Belg. 2010;110(2):190\u2013192.20873450"},{"issue":"6","key":"b10","series-title":"Neurosurgery","first-page":"E1750","article-title":"Delayed presentation of traumatic cerebral and dural arteriovenous fistulae after a BB gun accident in a pediatric patient: case report","volume":"68","author":"Abla AA","year":"2011","unstructured":"Abla AA, Albuquerque FC, Theodore N, Spetzler RF. Delayed presentation of traumatic cerebral and dural arteriovenous fistulae after a BB gun accident in a pediatric patient: case report. Neurosurgery. 2011;68(6):E1750\u2013E1754, discussion E1754\u2013E1755."},{"issue":"9","key":"b11","series-title":"Surg Neurol Int","first-page":"S219","article-title":"Middle meningeal arteriovenous fistulas: A rare and potentially high-risk dural arteriovenous fistula","volume":"7","author":"Almefty RO","year":"2016","unstructured":"Almefty RO, Kalani MY, Ducruet AF, Crowley RW, McDougall CG, Albuquerque FC. 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