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


METHODS
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.
Department of Neurosurgery, National Center for Global Health and Medicine, Gunma, Japan.
Takaaki
T
Miyagishima
Tetsuo
T
Hara
Masato
M
Inoue
Naruhiko
N
Terano
Hiroyasu
H
Ohno
Kouichiro
K
Okamoto
Kanehiro
K
Hasuo