Brainstem Venous Congestion Caused by Perimedullary Drainage in Anterior Cranial Fossa Dural Arteriovenous Fistula

BACKGROUND: Myelopathy develops relatively rarely in intracranial dural arteriovenous fistula (DAVF); it has only been reported in posterior cranial fossa DAVE Herein, we report the first, to our knowledge, case of anterior cranial fossa (ACF) DAVF with myelopathy. CASE DESCRIPTION: A 75-year-old man presented with dizziness, nausea, and gait disturbance. T2-weighted magnetic resonance imaging revealed a hyperintense area in the left cerebellum and medulla; a flow void was also detected around the medulla. The patient was first diagnosed with spinal DAVF, but the shunt point was detected at the anterior ethmoidal artery, flowing from the olfactory vein to the basal vein of Rosenthal and anterior/posterior spinal veins. The shunt point was clipped during craniotomy, and neurologic symptoms improved. CONCLUSIONS: Myelopathy because of intracranial DAVF potentially involves diagnostic pitfalls. Even in ACF DAVF, there is a possibility of myelopathy caused by perimedullary venous drainage.