J Cerebrovasc Endovasc Neurosurg.  2016 Jun;18(2):135-140. 10.7461/jcen.2016.18.2.135.

Transvenous Coil Embolization for Dural Arteriovenous Fistulas of the Ophthalmic Sheath: Report of Two Cases and Review of the Literature

• Hwang J
• Jo KI
• Yeon JY
• Hong SC
• Kim JS

• KMID: 2354890
• DOI: http://doi.org/10.7461/jcen.2016.18.2.135

Abstract

We present two patients with a dural arteriovenous fistula (dAVF) of the ophthalmic sheath who developed progressive exophthalmos, conjunctival chemosis, and visual loss. These symptoms mimic those of cavernous sinus dAVFs. Dural AVFs of the ophthalmic sheath are extremely rare and their clinical management is controversial. We successfully treated these two patients by transvenous coil embolization. Transvenous embolization appears to be a safe and effective method to treat dAVFs of the ophthalmic sheath.

Keyword

Dural arteriovenous fistula of ophthalmic sheath; Transvenous embolization; Superior ophthalmic vein; Inferior petrosal sinus; Facial vein

MeSH Terms

Cavernous Sinus
Central Nervous System Vascular Malformations*
Embolization, Therapeutic*
Exophthalmos
Humans
Methods

Figure

• 

  Fig. 1 Frontal (A) and superior (B) 3D TOF MRA maximum-intensity projections show a dilated left superior ophthalmic vein (white arrow). TOF MRA = time-of-flight magnetic resonance angiography.

• 

  Fig. 2 Lateral projection of left internal carotid angiogram shows dura AVFs of the left optic sheath (white arrow) with fine feeders from the ophthalmic artery and meningohypophyseal trunk (white arrowheads) (A, B). Left optic sheath dural AVF is shown to drain into the cavernous sinus (black arrow) (C). AVF = arteriovenous fistula.

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  Fig. 3 Angiogram shows the first coil (white arrowhead) inserted into the fistula point of the ophthalmic sheath in lateral view (A) and the fifth coil (white arrowhead) inserted into the shunting point via a transvenous approach. Microcatheter in the superior ophthalmic vein (white arrow) is seen on the lateral view (B) and the AP view (C). Angiogram after embolization shows complete obliteration of left optic sheath dural AVF (white arrowhead) and preserved ophthalmic artery (black arrow) (D). AVF = arteriovenous fistula.

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  Fig. 4 Angiogram shows dural AVF in the right optic sheath with feeders draining into the superior and inferior ophthalmic veins (white arrowhead) (A). Catheter is directly inserted into the superior ophthalmic vein (black arrow) (B). Coil is inserted into the fistula point of ophthalmic sheath in lateral view (white arrow) (C). Angiogram after embolization shows complete obliteration of right optic sheath dural AVF (white arrow) and preserved ophthalmic artery (black arrowhead) (D). AVF = arteriovenous fistula.

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