Abstract
A 56-year-old man presented with chemosis of the left eye. CT showed a dilated left superior ophthalmic vein, suggesting a carotid cavernous fistula. Cerebral angiogram revealed multiple dural arteriovenous fistulas at the superior sagittal sinus, the left lateral sinus and the jugular bulb, and multiple dural sinus occlusions involving the superior sagittal sinus, the left lateral sinus and the left inferior petrosal sinus. Arterial supply was from the branches of the external carotid artery and the meningeal branch of the vertebral artery. Venous drainage routes via the cortical vein to the cavernous sinus, via the deep cerebral vein to the straight sinus, and directly to the internal jugular vein were opcified. After embolization of the branches of the external carotid artery, chemosis was improved, but the dAVF of anterior part of the superior sagittal sinus supplied by the anterior falcine artery became more prominently visualized. The literature of multiple dAVF's was reviewed, and the mechanism of their development and clinical implication are discussed.
