• Jung-Soo Park and Jong-Myong Lee.
• Department of Neurosurgery, Jeonbuk sNational University Hospital and Medical School, Chon-Ju, Republic of Korea.
• Medicine (Baltimore). 2022 Jul 15; 101 (28): e29671e29671.

RationaleIntracranial brain surgeries, including ventriculostomy, burr hole, craniotomy, and craniectomy, are the most common causes of acquired dural arteriovenous fistula (dAVF). Here we report a case of acquired dAVF after a cerebellopontine angle meningioma surgery.Patient ConcernsA 51-year-old woman was diagnosed with a 40-mm cerebellopontine angle meningioma. The patient underwent surgery via a retrosigmoid suboccipital approach. A small craniotomy and an additional craniectomy were performed. At 7 months after the surgery, she presented with pulsating tinnitus and headache.DiagnosisMagnetic resonance imaging and digital subtraction angiography showed a dAVF that was fed by the occipital artery and drained into transverse and sigmoid sinuses.InterventionsWe performed Onyx® (Irvine, CA) embolization.OutcomesThe patient's symptoms completely improved.LessonsCraniectomy defects, partially exposed sinuses, and incomplete cranioplasty might be risk factors for iatrogenic dAVF after a retrosigmoid suboccipital craniotomy or craniectomy. Complete reconstructive cranioplasty is an essential procedure to prevent a direct connection between the venous sinus and the external carotid artery.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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