A case of the cavernous sinus dural arteriovenous fistula successfully treated with selective transarterial embolization of the fistulous point using platinum coils

Abstract

Objective: We report a case of cavernous sinus dural arteriovenous fistula (CdAVF) completely occluded by targeted embolization using coils.
Case presentation: A 30-year-old woman presented with left chemosis and ipsilateral exophthalmos. MRI showed left CdAVF. Angiographic examination showed a dural arteriovenous fistula at the left anterior compartment of the cavernous sinus supplied mainly by the accessory meningeal artery and draining mainly into the left superior ophthalmic vein. Endovascular treatment was performed using the transarterial approach. A microcatheter was advanced into the accessory meningeal artery. Superselective angiography demonstrated the fistula point at the inferolateral wall of the cavernous sinus. Placement of coils from the microcatheter to the fistulous point resulted in complete occlusion of the fistula and immediate improvement in the patient's symptoms.
Conclusion: Targeted transarterial embolization using coils may be the best treatment treatment option for select cases of CdAVF.