Article ID: cr.2020-0021
Objective: To show the case of cavernous sinus dural arteriovenous fistula (CS-dAVF) difficult for transvenous embolization treated by transarterial embolization (TAE) from the artery that fed cranial nerve with tris-acryl gelatin microspheres (embosphere) successfully.
Case Presentation: A 74-year-old woman presented with left conjunctival hyperemia, chemosis, exophthalmos and abducens nerve palsy. Magnetic resonance imaging showed signal void sign and dilation of the left superior ophthalmic vein. Cerebral angiography from the left external carotid artery showed the fistula between the cavernous sinus branch of middle meningeal artery and the lateral wall of left cavernous sinus, and she was diagnosed with left CS-dAVF. We tried transvenous embolization (TVE) but failed because of the complete occlusion of internal jugular vein as an access route to shunting point. Consequently, we tried transarterial embolization (TAE) using Embosphere to obstruct the proximal of cavernous sinus branch of MMA and the shunt disappeared. All the symptoms have been disappearing without recurrence in two years after TAE.
Conclusion: It is worth to try TAE with Embosphere in the case of dAVF as an alternative treatment of TVE.
