Article ID: cr.2022-0030
Objective: This study is based on a patient with cavernous sinus dural arteriovenous fistula (CS-dAVF) presented with brainstem edema. A prompt transvenous embolization was successfully performed on the patient, yielding a good outcome.
Case Presentation: An 80-year-old female patient developed CS-dAVF, initially presenting with conjunctival hyperemia and diplopia. MRI and MRA showed inflow into the posterolateral part of the cavernous sinus (CS) with a dilated right superior ophthalmic vein. During follow-up, she presented with progressive conjunctival hyperemia, and MRI re-examination revealed edema in the right medulla oblongata, right pons, and right midbrain. Cerebral angiography showed venous drainage from the right CS to the brainstem via the right pontine bridging vein (PBV). We performed transvenous embolization via the left inferior petrosal sinus, including the origin of the PBV, resulting in complete occlusion. Immediately after the surgery, the patient showed improvement of conjunctival hyperemia, and the brainstem edema was reduced.
Conclusion: Immediate therapeutic intervention may help prevent neurological deterioration in patients with CS-dAVF presented with brainstem edema.
