Fistulous shunt: digital subtraction angiography, post-intervention (1)

Anteroposterior (AP) and lateral views of the right external carotid artery injection show a hypertrophied middle meningeal artery (AP image 10 of 21, 1 sec). The enlarged middle meningeal artery has a fistulous connection with the superior sagittal sinus, which results in early and abnormal contrast opacification of the superior sagittal sinus (AP image 12 of 21, 1 sec, and lateral image 13 of 21, 7 sec). The fistulous drainage continues into the right transverse and sigmoid sinuses and right internal jugular vein (AP image 21 of 21, 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.)