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Fistulous shunt: digital subtraction angiography post-intervention (2)

Fistulous shunt: digital subtraction angiography post-intervention (2)

Anteroposterior (AP) and lateral views of the left external carotid artery injection show hypertrophy of several branches of the middle meningeal artery (AP image 8 of 22, 0 sec). The enlarged middle meningeal artery has a fistulous connection with the superior sagittal sinus. This results in early and abnormal contrast opacification of the superior sagittal sinus (AP image 13 of 22, 2 sec, and lateral image 12 of 22, 7 sec). The fistulous drainage continues into the right transverse and sigmoid sinuses and right internal jugular vein (AP image 20 of 22, 3 sec). This “arterialization” of the sinuses renders them incapable of receiving the normal venous drainage of the brain. (Contributed by Dr. Kristine Ann Blackham.)