2024 Volume 46 Issue 1 Pages 18-24
A 77-year-old woman with rapidly worsening tinnitus, bilateral conjunctival hyperemia, and diplopia was admitted to our hospital for treatment. Cerebral angiography revealed a dural arteriovenous fistula (DAVF) of the left cavernous sinus, which mainly drained from the left external carotid artery into the bilateral posterior cranial fossa and bilateral superior ophthalmic veins. Contrast-enhanced magnetic resonance imaging revealed a tumor suspected of left-sided sphenoid ridge meningioma. However, we treated this tumor conservatively. Although transvenous embolization was performed for DAVF, left eye symptoms worsened 15 days after the operation. Repeated cerebral angiography showed slight residual shunt and outflow from the sphenoid ridge tumor flowing into the left superior ophthalmic vein. Transarterial embolization was performed for the remaining shunt and feeding vessels to the tumor, and the symptoms improved. Herein, we report a suggestive case in which perfusion by a distant tumor was involved in a DAVF and present speculated therapeutic considerations for cases with similar anatomic pathology.
