Unique Venous Drainage of a Sphenoid Wing Dural Arteriovenous Fistula with Ocular Symptoms

• Published in: World neurosurgery 2017-01, Vol.97, p.753.e1-753.e5
• Main Authors: Misaki, Kouichi, Uchiyama, Naoyuki, Mohri, Masanao, Aida, Yasuhiro, Uno, Takehiro, Nakada, Mitsutoshi
• Format: Article
• Language: English
• Subjects: Central Nervous System Vascular Malformations - complications; Central Nervous System Vascular Malformations - diagnosis; Central Nervous System Vascular Malformations - therapy; Cerebral Veins - abnormalities; Cerebral Veins - diagnostic imaging; Conjunctival Diseases - diagnosis; Conjunctival Diseases - etiology; Conjunctival Diseases - prevention & control; Diagnosis, Differential; Dural arteriovenous fistula; Edema - diagnosis; Edema - etiology; Edema - prevention & control; Embolization, Therapeutic - methods; Exophthalmos - diagnosis; Exophthalmos - etiology; Exophthalmos - prevention & control; Female; Greater sphenoid wing; Humans; Middle Aged; Neurosurgery; Superior orbital vein; Target coil embolization; Transvenous embolization; Treatment Outcome; Venous thrombus; Vision Disorders - diagnosis; Vision Disorders - etiology; Vision Disorders - prevention & control
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.10.055

Background Dural arteriovenous fistulas (DAVFs) presenting with ocular symptoms, such as exophthalmos and chemosis, are commonly situated in the cavernous sinus (CS). DAVFs at the sphenoid wing with a drainage route into the superior orbital vein (SOV) should be considered as one of the differential diagnoses of ocular symptoms. Case Description A 41-year-old woman presented with progressive left-sided chemosis and proptosis after left pulsating tinnitus that disappeared spontaneously. Cerebral angiography showed that the fistula was situated along the inferior edge of the superior orbital fissure on the greater sphenoid wing and drained solely into the SOV without flowing into the CS that caused ocular symptoms. Transvenous selective catheterization was performed via the facial vein and SOV. The fistula was then embolized using detachable coils. Conclusions After embolization, the ocular symptoms resolved, and the patient was discharged without neurologic deficit. Herein, we discuss the developmental mechanism of the unique drainage pattern, including the clinical symptoms and anatomic features of greater sphenoid wing DAVFs.