Regression of a Flow-Related Ophthalmic Artery Aneurysm After Treatment of a Frontal DAVS. A Case Report

Abstract

We report a case of a frontal dural arteriovenous shunt or fistula (DAVS) adjacent to the left side of the cribriform plate, with bilateral supply from multiple arteries, the most prominent being the dural branches originating from the anterior ethmoidal artery coming from the left ophthalmic artery. Before treatment there was an eight mm flow-related arterial aneurysm proximally on the left ophthalmic artery. After transarterial embolization of the DAVS with N-butyl cyanoacrylate and polyvinyl alcohol, minimal shunting still remained. At follow-up angiography six months after the treatment, the shunt was obliterated and the ophthalmic artery aneurysm had regressed completely. Our case illustrates that complete obliteration of a DAVS may be achieved even though arteriovenous shunting remains at the end of the procedure. Furthermore, a flow-related arterial aneurysm, may not warrant any specific treatment. Elimination of the high flow situation can lead to complete regression of these aneurysms.

Figure 1

Lateral view of pre-embolization left ICA angiogram (A) shows the DAVS fed by dural branches from the anterior ethmoidal artery. Note the flow-related aneurysm located proximally on the ophthalmic artery. At follow-up cerebral angiography six months after the treatment (C), the shunt was totally occluded and the ophthalmic artery aneurysm had regressed completely.