2022 Volume 50 Issue 1 Pages 64-69
Dural arteriovenous fistulas (dAVFs) of the lesser sphenoid wing region are rare. We report a case of a dAVF of the lesser sphenoid wing region with leptomeningeal drainage.
A 79-year-old man consulted the Department of Neurosurgery for examination of a dAVF of the anterior cranial fossa, which was incidentally revealed on magnetic resonance imaging. Angiography demonstrated a dAVF of the lesser sphenoid wing region; the fistula was supplied by the recurrent meningeal artery (RMA) via the ophthalmic artery and the inferolateral trunk (ILT) from the left internal carotid artery. Multiple feeders were noticed originating from the left external carotid artery, such as the artery of foramen rotundum (AOR), accessory meningeal artery (AMA), and middle meningeal artery (MMA). The fistula drained into the deep middle cerebral vein via the uncal vein and the frontal cortical vein via the superficial middle cerebral vein, which had varices. The patient was scheduled for endovascular treatment, and transarterial embolization (TAE) was performed. The RMA, ILT, and AOR were occluded using platinum coils, while the AMA was occluded using n-butyl-2-cyanoacrylate (NBCA). The fistula was completely embolized via the MMA using NBCA. No adverse events were noticed, and the fistula was successfully obliterated.
dAVFs of the lesser sphenoid wing region are rare, and TAE using NBCA is a useful treatment for this condition.
