Dural Arteriovenous Fistula with Shunt Restricted to the Superior Orbital Fissure: A Case Report

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Objective: Dural arteriovenous fistulas (DAVFs) in the superior orbital fissure (SOF) are extremely rare. We report a case of DAVF in the SOF and discuss the characteristics of angioarchitecture and the treatment strategies.

Case Presentation: A 72-year-old woman presented with chemosis, exophthalmos. Digital subtraction angiography revealed a right SOF DAVF mainly supplied from the accessory meningeal artery and the ophthalmic artery, which drained into the facial vein (FV) through the superior ophthalmic vein (SOV) without drainage into the cavernous sinus. A microcatheter was introduced into the shunt pouch via the FV and SOV, and coil embolization of the shunt pouch and SOV was performed, resulting in complete occlusion. However, 1 month later, DAVF recurred, with increased intraocular pressure and decreased vision. A semi-emergent transarterial glue embolization from the accessory meningeal artery was performed and complete occlusion was obtained.

Conclusion: SOF DAVFs often lack cavernous sinus drainage, and transvenous embolization via the FV is recommended if FV drainage is present, but transarterial embolization may be the next treatment of choice if transvenous embolization is unsuccessful.