Traumatic Arteriovenous Fistula Between Extracranial Middle Meningeal Artery and Petrosal Vein

Background: The incidence of traumatic arteriovenous fistula (TAVF) between the middle meningeal artery (MMA) and the petrosal vein (PV) is rare. Although TAVF has been reported involving the MMA several sinus and veins, this is the first incidence of a fistula involving the extracranial MMA and PV. Case Description: We present a 47-year-old male with sudden onset of weakness of his right limb and speech difficulty a few hours before admission to our facility. He had a 6-month history of mild traumatic head injury. Initial computed tomography revealed midbrain hemorrhage while digital subtraction angiography revealed a TAVF of the left MMA. Enhanced magnetic resonance imaging, however, revealed communication between the MMA and PV. We treated the patient with coil embolization via the transarterial route. Conclusions: This is the first incidence of a fistula connecting the extracranial MMA and PV. We managed the patient with only coil embolization without any further neurologic deficits.