Sphenoid wing dural arteriovenous fistula: A case report and literature review

Abstract

Background: Sphenoid wing dural arteriovenous fistula (SWDAVF) is rare that is typically fed by middle meningeal artery feeders and that drain through the sphenoparietal sinus or middle cerebral vein. Here, we report a case of SWDAVF treated by coils placed in the venous aneurysm through the contralateral cavernous sinus (CS).

Case description: A 37-year-old woman was admitted to our hospital with headache and bilateral oculomotor nerve palsy. Magnetic resonance images and an angiogram showed a venous aneurysm in the right middle cranial fossa. A DAVF, consisting of two main feeders, was diagnosed based on the angiogram findings. The fistula drained into the left inferior petrosal sinus (IPS) through the left CS and right IPS. Given the remarkable extent of venous ectasia together with the headache and right abducens nerve paralysis, endovascular treatment was initiated. A transvenous approach through the right IPS was not feasible, as it is strenuous to insert the microcatheter into the right IPS. Thus, we tried an approach through the left IPS. The venous aneurysm was embolized with coils. The postoperative course was uneventful, and postoperative cerebral angiography confirmed disappearance of the fistula.

Conclusion: A SWDAVF is extremely rare. In our case, since the AVF drained into the contralateral CS, contralateral ocular symptoms occurred. Endovascular occlusion of the venous aneurysm and fistula was achieved through a transvenous approach.

Keywords: Cavernous sinus; Dural arteriovenous fistula; Endovascular; Venous aneurysm.

Figure 1:

Time-of-flight magnetic resonance (MR) images (a) and MR angiography (b) show a venous aneurysm in the right middle cranial fossa and dural arteriovenous fistula around the aneurysm (white arrow).

Figure 2:

(a and b) Right external carotid artery injection, frontal view. A large venous varix rapidly fills with early drainage into the superior orbital vein, left cavernous sinus, and inferior petrosal sinus. The feeding of the dural arteriovenous fistula (DAVF) through the middle meningeal artery is observed. (c) Superselective catheterization of the middle meningeal artery (MMA) shows feeding of the DAVF through the petrosal branch of the MMA.

Figure 3:

(a) Venous aneurysm is completely obliterated by the coil mass. (b) Frontal view. (c) Lateral view, final right external carotid angiography showing complete obliteration of the fistula.

Figure 4:

Time-of-flight magnetic resonance (MR) images (a) and MR angiography (b) demonstrate that the venous aneurysm and dural arteriovenous fistula disappeared after coil embolization.