Pontine venous congestion due to dural arteriovenous fistula of the cavernous sinus: Case report and review of the literature

Abstract

Background:We report herein a case of cavernous sinus (CS)-dural arteriovenous fistula (DAVF) with brainstem venous congestion that was successfully treated by transarterial embolization, followed by radiotherapy.Case Description:An 80-year-old woman presented with right eye chemosis and left hemiparesis. T2-weighted magnetic resonance imaging showed hyperintensity of the pons. Diagnostic cerebral angiography demonstrated CS-DAVF draining into the right superior orbital vein and petrosal vein, and fed by bilateral internal and external carotid arteries. Transarterial embolization was performed and followed by radiotherapy, resulting in resolution of the pontine lesion and neurological and ophthalmological symptoms within 5 months.Conclusions:We also review the literature regarding therapy for CS-DAVF with brainstem venous congestion. Once CS-DAVF with venous congestion of the brainstem has been definitively diagnosed, immediate therapy is warranted. Treatment with transarterial embolization followed by radiation may be an important option for elderly patients when transvenous or transarterial embolization is not an option.

Acute Brainstem Dysfunction Caused by Cavernous Sinus Dural Arteriovenous Fistula

“…Single drainage route via the right petrosal vein caused venous reflux into posterior fossa, and subsequent focal venous congestion caused acute brainstem dysfunction and hemorrhagic infarction. Orbital or ocular symptoms had preceded brainstem symptoms in all nine cases previously reported in the English literature [5][6][7][8][9][10], but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dAVFs lack orbital or ocular symptoms and mimic inflammatory diseases when the clinical course is acute.…”

A Case of Cavernous Sinus Dural Arteriovenous Fistula Presenting with Medulla Oblongata Dysfunction in Parallel to Thrombosis of a Varix on a Drainage Route after Transvenous Embolization

“…Concerning CSdAVF, 10 cases were reported. 2) In each of them, neurological and imaging findings improved after the shunt flow disappeared. On the other hand, in the present case, medulla oblongata dysfunction exacerbated and an edematous change enlarged after the shunt disappeared, which require the different mechanism from increased shunt flow.…”

Resolution of brainstem edema after treatment of a dural tentorial arteriovenous fistula

“…Cavernous sinus dural arterio-venous malformations with dominant or exclusive drainage through the superior petrosal sinuses and posterior fossa veins have been associated to brainstem congestion. [17][18][19][20][21] Reports of tentorial, sigmoid and transverse sinus dural fistulas causing brainstem edema mimicking brainstem tumors or arterial infarctions have also been described. [22][23][24][25] All of these lesions are vascularized by a network of dural arteries and become symptomatic when they interfere with the venous drainage of the ponto-mesencephalic and medullary regions.…”