PURPOSE: Arteriovenous fistulas that involve the cavernous sinus often produce ophthalmologic symptoms and signs. Transvenous endovascular access is the method of choice for a carotid-cavernous sinus fistula. The superior ophthalmic vein is a safe and reasonable alternative route for the transvenous embolization of carotid-cavernous sinus fistula. We report a case of the embolization of a carotid-cavernous sinus fistula using the superior ophthalmic vein approach. METHODS: A 58 year old female had conjunctival congestion, periocular pain and diplopia with a 2 month duration. Diagnostic orbital CT, brain MRI and cerebral angiography revealed a carotid-cavernous sinus fistula. The fistula occlusion was treated by coil embolization using the superior ophthalmic vein approach. RESULTS: The initial presenting symptoms, conjunctival congestion, periocular pain and diplopia, decreased after surgery. Coil embolization via the superior ophthalmic vein approach was difficult because of the venous tortuosity and friability. During the follow up period, the patient was in a good condition without complications. CONCLUSION: Surgical exposure of the superior ophthalmic vein provides direct venous access to the cavernous sinus as well as an effective and safe treatment approach. The cooperation of the plastic surgeon and interventionist is a factor in successful treatment.
Arteriovenous Fistula ; Brain ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Cerebral Angiography ; Diplopia ; Estrogens, Conjugated (USP) ; Female ; Fistula ; Follow-Up Studies ; Humans ; Orbit ; Veins

PURPOSE: To evaluate the MR findings of dural arteriovenous fistula(DAVF) in the cavernous sinus and to determine the most useful imaging method for the diagnosis of DAVF. MATERIALS AND METHODS: We evaluated the MR findings of 12 patients in whom DAVF was diagnosed in the cavernous sinus on the basis of angiographic findings. Axial T1- and T2-weighted, and axial and coronal Gd-enhanced T1-weighted images with 3-6mm slice thickness had been obtained, and the findings of DAVF on three pulse sequences were examined and compared. On the basis of the detection of DAVF on three pulse sequences, the MR findings were graded as excellent, fair or poor, and the location of DAVF in the cavernous sinus was analysed. We also classified DAVFs as group A or B on the basis of MR findings (group A: lesions in the cavernous sinus were as large as or larger than the cavernous internal carotid artery; group B: these were smaller than the cavernous internal carotid artery) and compared with cognard type on angiogram. RESULTS: Multiple tortuous signal voids were found in all DAVFs. The signal voids were located mainly in the middle and posterior one third of the cavernous sinus, as seen on axial images, and the middle and inferior one third, as seen on coronal images. Axial and coronal enhanced T1-weighted images showed an excellent grade in 11 of 12 cases and a fair grade in 1 of 12. Axial T2-weighted images showed an excellent grade in 6 of 12 cases and a fair grade in 4 of 12. T1-weighted images showed an excellent grade in 4 of 12 cases and a fair grade in 6 of 12. Six cases were group A, and 5 of the 6 were Cognard type IIa or IIb; The other 6 cases were group B, 5 of the 6 were Cognard type I. CONCLUSION: MR findings of multiple tortuous signal voids in the cavernous sinus, especially in the posterior or inferior portion, suggest DAVF, and enhanced T1-weighted imaging could be the most useful sequence for its diagnosis.
Arteriovenous Fistula ; Carotid Artery, Internal ; Cavernous Sinus* ; Central Nervous System Vascular Malformations* ; Diagnosis ; Humans

Dural arterio-venous malformations are vascular communications in which blood flows through small meningeal branches of the carotid arteries to enter the venous circulation near the cavernous sinus. Dural arterio-venous malformations are distinct neuroophthalmological syndrome which consisisted of symptoms such as exphthalmos, increased intraocular pressure, ipsilateral headache, and dilatation of episcleral vessels, but they are difficult to diagnose clinically. Moreover it is difficult to differentiate them from the more common carotid-cavernous fistulas which represent similar symptoms of dural arteio-venous malformations. We report a case of dural arteriovenous malformation, involving the cavernous sinus and confimed with selective carotid arteriography, in a patient who presented with symptoms of unilateral tinnitus, conjunctival injection, and raised intraocular pressure, along with the review of literatures.
Angiography ; Arteriovenous Malformations ; Carotid Arteries ; Cavernous Sinus* ; Dilatation ; Fistula ; Headache ; Humans ; Intraocular Pressure ; Tinnitus

Adult ; Arteriovenous Fistula ; therapy ; Balloon Occlusion ; adverse effects ; Carotid-Cavernous Sinus Fistula ; therapy ; Cavernous Sinus ; abnormalities ; Dura Mater ; blood supply ; Humans ; Male ; Meningeal Arteries ; abnormalities

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Arteriovenous Fistula*

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Arteriovenous Fistula*

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Arteriovenous Fistula*

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Arteriovenous Fistula*

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Arteriovenous Fistula*

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Arteriovenous Fistula*