Ethmoidal dural arteriovenous fistula with unusual drainage route treated by transarterial embolization

Abstract

SUMMARYEthmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. In particular, this entity with reflux drainage directly into the ophthalmic vein is extremely rare. We report a case of ethmoidal dural AVF with direct drainage of the superior ophthalmic vein (SOV) and inferior ophthalmic vein (IOV), successfully treated by endovascular surgery. A 58-year-old man presented with progressive diplopia. Angiography and contrast-enhanced CT showed an ethmoidal dural AVF supplied via the bilateral anterior ethmoidal arteries and venous drainage through the left SOV and IOV. A transarterial approach through the bilateral anterior ethmoidal arteries was used to place the microcatheter close to the fistula site. After intra-arterial embolization with 20% N-butyl cyanoacrylate, the dural AVF was completely occluded. In patients with good vascular access, endovascular transarterial embolization may be an effective and less invasive treatment strategy for ethmoidal dural AVF. BACKGROUND

Anterior cranial fossa osseous arteriovenous fistula of the crista galli with bone erosion: patient series

“…However, the drainage to the superior ophthalmic vein or nasal bleeding pattern has rarely been documented. 7–9 In other words, the minority of patients have an extracranial drainage pattern. If a shunt point is present inside the dural surface, the draining vein must penetrate both the rigid dura and the skull twice.…”

Successful endovascular treatment of ruptured bilateral ophthalmic frontal dural arteriovenous fistula

“…High risk for fatal hemorrhage is associated because of their cortical venous drainage [2] . Previous reports and series, these kinds of lesions have been addressed as challenging and difficult lesion to treat via the endovascular approach [5] , [6] . Halback et al.…”

Ethmoidal dural arteriovenous fistulas: endovascular transvenous embolization technique

“…The transvenous endovascular approach may be a useful tool in treating these lesions; however, access and tortuosity of structures proximal to the fistula point have to be thoroughly assessed. We review the natural history and angio-architecture of these lesions 5–7. Important tips and bailout maneuvers for treatment of complex ethmoidal dAVFs in eloquent locations are also presented.…”