Transarterial embolization with coils via accessory meningeal artery for the cavernous sinus dural arteriovenous fistula: a case report

Abstract

Objective: We hereby report a rare case of Barrow type B cavernous sinus dural arteriovenous fistula (CSdAVF) thatwas treated by coiling the affected sinus through a trans-arterially placed microcatheter via the ipsilateral accessorymeningeal artery (AMA).
Case presentation: A 75-year-old man presented with chemosis and exophthalmos on his left eye. The patient didnot have a previous medical history of head trauma. Left external carotid artery angiogram revealed a CSdAVF withtwo feeders, the accessory meningeal artery and artery of foramen rotundum. Retrograde venous drainage was seen tothe ipsilateral superior orbital and deep middle cerebral veins. During the intervention, a microcatheter was advancedbeyond the fistula into the cavernous sinus through the large AMA. The microcatheter was easily manipulated in thesinus and packing of the sinus was achieved with coils.
Conclusion: A rare case of CSdAVF treated by trans-arterial coiling via the AMA is reported. The trans-arterialapproach to the cavernous sinus may be an unexpected option and should be considered in case with limited access tothe sinus.