A Patient with a Cavernous Sinus Dural Arteriovenous Fistula in Whom Direct Puncture of the Superior Ophthalmic Vein Led to Rapidly Progressing Thrombosis and Postoperative Non-arteritic Ischemic Optic Neuropathy: Pathogenesis with Respect to a Drainage Route

Narihide Shinoda; Masafumi Mori; Shogo Tamura; Kazuyoshi Korosue; Shigeru Kose; Hiroto Imai; Tetsuya Enomoto; Ryouichi Tominaga; Toshio Masahira; Tatsuya Miki; Tomoya Hiura; Ken Shimoda; Keiichiro Suwa; Junichi Obata; Mutsuma Adachi; Yasushi Matsumoto; Eiji Kohmura

doi:10.5797/jnet.cr.2018-0069

Case Reports

A Patient with a Cavernous Sinus Dural Arteriovenous Fistula in Whom Direct Puncture of the Superior Ophthalmic Vein Led to Rapidly Progressing Thrombosis and Postoperative Non-arteritic Ischemic Optic Neuropathy: Pathogenesis with Respect to a Drainage Route

Narihide Shinoda, Masafumi Mori, Shogo Tamura, Kazuyoshi Korosue, Shigeru Kose, Hiroto Imai, Tetsuya Enomoto, Ryouichi Tominaga, Toshio Masahira, Tatsuya Miki, Tomoya Hiura, Ken Shimoda, Keiichiro Suwa, Junichi Obata, Mutsuma Adachi, Yasushi Matsumoto, Eiji Kohmura

Author information

Narihide Shinoda
Department of Neurosurgery, Kosei Hospital, Kobe, Hyogo, Japan
Masafumi Mori
Department of Neurosurgery, Kosei Hospital, Kobe, Hyogo, Japan
Shogo Tamura
Department of Neurosurgery, Kosei Hospital, Kobe, Hyogo, Japan
Kazuyoshi Korosue
Department of Neurosurgery, Kosei Hospital, Kobe, Hyogo, Japan
Shigeru Kose
Department of Neurosurgery, Kosei Hospital, Kobe, Hyogo, Japan
Hiroto Imai
Department of Anesthesiology, Kosei Hospital, Kobe, Hyogo, Japan
Tetsuya Enomoto
Department of Clinical Engineering, Kosei Hospital, Kobe, Hyogo, Japan
Ryouichi Tominaga
Department of Radiological Technology, Kosei Hospital, Kobe, Hyogo, Japan
Toshio Masahira
Department of Radiological Technology, Kosei Hospital, Kobe, Hyogo, Japan
Tatsuya Miki
Department of Radiological Technology, Kosei Hospital, Kobe, Hyogo, Japan
Tomoya Hiura
Department of Radiological Technology, Kosei Hospital, Kobe, Hyogo, Japan
Ken Shimoda
Department of Radiological Technology, Kosei Hospital, Kobe, Hyogo, Japan
Keiichiro Suwa
Department of Radiological Technology, Kosei Hospital, Kobe, Hyogo, Japan
Junichi Obata
Department of Radiological Technology, Kosei Hospital, Kobe, Hyogo, Japan
Mutsuma Adachi
Department of Radiological Technology, Kosei Hospital, Kobe, Hyogo, Japan
Yasushi Matsumoto
Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
Eiji Kohmura
Department of Neurosurgery, Kobe University Hospital, Kobe, Hyogo, Japan

Keywords: cavernous sinus dural arteriovenous fistula, superior ocular vein direct puncture, ischemic optic neuropathy, thrombosis

JOURNAL OPEN ACCESS

2019 Volume 13 Issue 5 Pages 221-227

DOI https://doi.org/10.5797/jnet.cr.2018-0069

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Abstract

Objective: We report a patient in whom direct puncture of the superior ophthalmic vein for a cavernous sinus dural arteriovenous fistula led to rapidly progressing thrombosis and postoperative non-arteritic ischemic optic neuropathy (NA-ION), and review the pathogenesis.

Case Presentation: A 74-year-old female. Detailed examination of diplopia and visual disorder suggested a cavernous sinus dural arteriovenous fistula. As approaching via a posterior route was difficult, transvenous embolization by direct puncture of the superior ophthalmic vein was performed. As drainage routes were aggregated around this vein, thrombosis of this vein occurred, inducing postoperative NA-ION through a rapid change in hemodynamics.

Conclusion: When performing direct puncture of the superior ophthalmic vein, puncture methods and heparinization should be considered after sufficiently investigating drainage routes.

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