Abstract
Objective: We hereby report a rare case of Barrow type B cavernous sinus dural arteriovenous fistula (CSdAVF) that was treated by coiling the affected sinus through a trans-arterially placed microcatheter via the ipsilateral accessory meningeal artery (AMA).
Case presentation: A 75-year-old man presented with chemosis and exophthalmos on his left eye. The patient did not have a previous medical history of head trauma. Left external carotid artery angiogram revealed a CSdAVF with two feeders, the accessory meningeal artery and artery of foramen rotundum. Retrograde venous drainage was seen to the ipsilateral superior orbital and deep middle cerebral veins. During the intervention, a microcatheter was advanced beyond the fistula into the cavernous sinus through the large AMA. The microcatheter was easily manipulated in the sinus 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-arterial approach to the cavernous sinus may be an unexpected option and should be considered in case with limited access to the sinus.
