A case of intracranial dural arteriovenous fistula coexisted with orbital cavernous malformation

Abstract

A 37-year-old woman was admitted to our hospital with retro-orbital pain, chemosis, and vascular bruit. Magnetic resonance imaging revealed a varix in the right middle cranial fossa and dilated superior ophthalmic vein with orbital cavernous malformation (CM). Cerebral angiography demonstrated dural arteriovenous fistula (DAVF) of middle cranial fossa fed by branches from external carotid artery. We performed transvenous endovascular embolization of DAVF. Postoperative angiography and MRI showed disappearance of the fistula, reduction of CM and her symptoms were improved. Nine months later, chemosis and exopthalmos developed suddenly and MRI showed relapse of DAVF and orbital CM which was more dilated than before. We treated with endovascular treatment again, DVAF was disappeared and CM was reduced immediately. The coexistence of DAVF of middle cranial fossa and orbital CM is extremely rare, but may indicate the underlying mechanism of the formation and regrowth of CM.