C43 Anterior cranial fossa dural arteriovenous fistula detected on arterial spin labeling mri, successfully treated with transarterial embolization

<h3>Introduction</h3> MR angiography is a commonly used modality for the initial diagnosis of dural arteriovenous fistulas (dAVFs). However, dAVFs with minimal shunt flow are sometimes missed. We present a case of an anterior cranial fossa (ACF) dAVF detected by arterial spin labeling (ASL) MRI and successfully treated with transarterial embolization. <h3>Case Description</h3> A man in his 80s presented with multiple cortical infactions due to the ipsilateral internal carotid artery stenosis. During the diagnostic evaluation for carotid artery stenosis, 3D-pseudocontinuous ASL MRI revealed prominent intravascular signals overlying the left frontal lobe, whereas MR angiography showed minimal cortical vessels of unclear significance. Cerebral angiography demonstrated a non-sinus-type ACF dAVF, with feeding from bilateral anterior and posterior ethmoidal arteries and direct drainage into cortical veins (Borden type III). Given the patient‘s condition and favorable anatomy for accessing the shunt point, transarterial embolization was performed following carotid artery stenting. A microcatheter was advanced via the left anterior ethmoidal artery to a position just proximal to the shunt point at the cribriform plate. A single injection of n-butyl-cyanoacrylate successfully obliterated of the shunt. The patient experienced no neurological or visual complications throughout the course. <h3>Conclusions</h3> Even when MR angiography yields inconclusive findings—especially in cases with minimal shunting—ASL MRI can offer additional diagnostic value for dAVFs. Additionally, endovascular treatment for ACF dAVFs has recently emerged as a preferred alternative to conventional direct surgery, particularly in patients with comorbidities and favorable angioarchitecture. <h3>Conflict of Interest</h3> No