Ruptured Posterior Inferior Cerebellar Artery Dural Fistula After Vestibular Schwannoma Resection.

A 50-year-old man with a history of left-sided retrosigmoid craniotomy for vestibular schwannoma (VS) resection 19 years prior presented with severe headache and left cerebellopontine angle subarachnoid hemorrhage (SAH). Digital subtraction angiography demonstrated a dissected, nonfunctional left posterior inferior cerebellar artery with direct fistulization at the left transverse sinus (Video 1). The lesion was treated with endovascular Onyx embolization. The patient recovered without neurologic deficit. Five additional cases of new dural arteriovenous fistula arising after VS resection have been described; we report the first such case presenting with SAH, suggesting that postoperative magnetic resonance angiography may be of value in long-term VS follow-up imaging protocols.