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Case report
Ethmoidal dural arteriovenous fistula with unusual drainage route treated by transarterial embolization
  1. Akihiro Inoue1,
  2. Masahiko Tagawa1,
  3. Yoshiaki Kumon1,
  4. Hideaki Watanabe1,
  5. Daisuke Shoda2,
  6. Kenji Sugiu3,
  7. Takanori Ohnishi1
  1. 1Department of Neurosurgery, Ehime University School of Medicine, Toon-shi, Ehime, Japan
  2. 2Department of Neurosurgery, Uwajima City Hospital, Uwajima-shi, Ehime, Japan
  3. 3Department of Neurosurgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
  1. Correspondence to Dr Akihiro Inoue, Department of Neurosurgery, Ehime University School of Medicine, Toon-shi, Ehime, Japan 791–0295, iakihiro3{at}gmail.com

Abstract

Ethmoidal 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.

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