Cavernous sinus dural arteriovenous fistula treated by an approach through the anterior jugular vein involving facial vein return: A case report

Abstract

  We report the case of a patient with a cavernous sinus (CS) dural arteriovenous fistula (dAVF) with ocular symptoms who was treated with transvenous embolization (TVE) via the facial vein (FV) connecting to the anterior jugular vein (AJV). A 76‒year‒old Japanese woman was referred to our hospital for a detailed investigation and treatment of left exophthalmos, eye pain, and diplopia. Magnetic resonance and digital subtraction angiography showed that the shunt point was the left CS, and the main venous drainage route was retrograde from the left cavernous sinus to the left superior orbital vein (SOV) due to an obstruction of the antegrade drainage route. The first TVE session resulted in no embolization of the fistula due to poor accessibility into the left CS, and postoperative computed tomography angiography (CTA) disclosed a drainage route into the left FV connecting to the left AJV and jugular venous arch. The patient underwent a second session of TVE with left AJV puncture using echo through the left AJV, FV, and SOV, and obliteration was achieved. Considerable variation exists in the anatomy of the faciocervical veins in patients with a CS dAVF. A meticulous preoperative evaluation of the venous drainage route using CTA is indispensable to achieving successful treatment outcomes in patients with a CS dAVF.