Non-Sinus-Type Laterocavernous Sinus Dural Arteriovenous Fistula Treated by Transarterial Venous Coil Embolization: A Case Report

Abstract

Laterocavernous sinus dural arteriovenous fistulas (DAVFs) are rare and not always accessible transvenously due to their angioarchitecture. We report a case of non-sinus-type laterocavernous sinus DAVF treated by endovascular transarterial venous coil embolization.Case Presentation: A 78-year-old woman was admitted to our hospital with loss of consciousness, right hemiparesis, and motor aphasia. CT demonstrated intracerebral hematoma in the left frontal lobe and subarachnoid hemorrhage. On CTA and MRA, a DAVF was found in the left laterocavernous sinus region associated with the accessory meningeal artery (AMA) and draining directly into the superficial middle cerebral vein. The diagnosis was confirmed by DSA, which revealed a DAVF fed by the large and straight AMA and the internal carotid artery's meningohypophyseal trunk.Endovascular transarterial venous coil embolization was performed through the AMA. A microcatheter was advanced beyond the shunt point into the origin of the draining vein, and coils were placed in the venous and arterial sides of the fistula. The fistula was completely occluded, and 15-month follow-up angiography demonstrated stable obliteration of the fistula. Conclusion:Transarterial venous coil embolization may be a treatment option for non-sinus-type laterocavernous sinus DAVF with a large fistula size and a large and straight feeding artery.Keywords▶ middle fossa dural arteriovenous fistula, sphenoid wing, transarterial venous embolization, coil, endovascular therapy

Sphenoid Wing Dural Arteriovenous Fistulas

“…Our review of the literature revealed 20 cases of greater sphenoid wing DAVFs (Table 2). 4,9,[17][18][19][20][21][22][23][24][25][26][27] The median age of the patients was 53 years (range, 8-78 years), and 12 patients (60%) were males, with no obvious gender differences as seen in the lesser sphenoid wing lesions. A total of 13 lesions (65%) with CVR were reported, all with varices in the draining vein.…”

Endovascular treatment for sphenoidal region dural arteriovenous fistula

“…In addition to the anatomical location, there are other classifications for sphenoidal region DAVFs. These tumors can also be divided into fine-network and single-channel types based on the fistulous structure, into high-flow and low-flow types based on the shunting blood flow, and into dural type and intraosseous diploic types based on the remodeling or erosion of the sphenoid bone ( 28 , 29 , 36–38 ).…”

“…The most important feeding arteries for these lesions arose from the MMA and AMA of the ECA. The meningeal branches of the ICA included the ILT and the recurrent meningeal branch from the OphA ( Figure 3A ) ( 30 , 32 , 36 ). Sphenoid region DAVFs can recruit additional feeding arteries, such as the MHT, ethmoidal branch of the OphA, artery of the foramen rotundum, deep temporal artery, meningoorbital artery, superficial temporal artery, anterior auricular artery, and ascending pharyngeal artery ( 1–3 , 5 , 9 , 30 , 33 , 39–41 ).…”

“…The basal vein of Rosenthal anastomosis to the lateral mesencephalic vein may result in drainage into the venous system of the brainstem ( 47 ). Venous hypertension often results in ectasias and aneurysms in the arterialized draining vein ( 8 , 31 , 36 , 48 ). Therefore, Borden type III and Cognard type IV lesions are common ( 49 , 50 ).…”

“…For DAVFs with a venous recipient pouch, if the fistula connection or venous recipient pouch can be catheterized, only coiling may be sufficient ( 4 , 36 , 43 ). Coils can be delivered by microcatheters (0.014 in.)…”