• Aqueel H Pabaney, Adam M Robin, Azam Basheer, and Ghaus Malik.
• Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA. Electronic address: apabane1@hfhs.org.
• World Neurosurg. 2016 May 1; 89: 731.e7-731.e11.

BackgroundDevelopment of dural arteriovenous fistula (dAVF) with cortical venous drainage at the site of previous craniotomy is a rare manifestation of nontraumatic subarachnoid hemorrhage (SAH). The authors present a case of postcraniotomy dAVF formation and discuss plausible underlying mechanisms of fistula formation and treatment options as well as review the literature.Case DescriptionA 62-year-old man, who had undergone craniotomy 2 decades previously, presented with SAH. Workup revealed a low-flow dAVF with leptomeningeal venous drainage at the posterior margin of the craniotomy. Surgical resection of fistula was undertaken that resulted in cure.ConclusionsSpontaneous SAH in patients with a previous history of an intracranial procedure (e.g., craniotomy, ventriculostomy) should prompt detailed imaging evaluation. In the absence of vascular disease, meticulous review of the angiogram must be undertaken to rule out dAVF at the procedure site and it should be treated definitively.Copyright © 2016 Elsevier Inc. All rights reserved.

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