Cavernous sinus dural arteriovenous fistula with bone erosion: case report

Abstract

Objective: A case of cavernous sinus dural arteriovenous fistula (dAVF) with bone erosion is reported.
Case presentation: A 69-year-old female presented with pulsatile tinnitus and diplopia. Cerebral angiography showed multiple fistulas in bilateral cavernous sinuses and a venous pouch adjacent to the left cavernous sinus with venous drainage into bilateral superior ophthalmic veins, as well as cortical venous reflux into the superficial middle cerebral and cerebellar veins. 3-dimensional dynamic CT revealed early filling of bilateral cavernous sinuses, and coronal multi-planar reconstruction images in the bone window demonstrated bone erosion on the dorsum sellae adjacent to the venous pouch. We considered that the bone erosion was caused by both the venous pouch and related vessels of the dAVF. Transvenous coil embolization resulted in disappearance of the dAVF.
Conclusion: The proximity of bone erosion to both fistulous points and venous pouch provided useful adjunctive information regarding angioarchitecture of dAVF and thus facilitated transvenous embolization.