title: Aberrant venous drainage pattern in a medial sphenoid wing dural arteriovenous fistula: a case report and review of the literature.
abstract: BACKGROUND
  Sphenoid wing region dural arteriovenous fistulas (DAVFs) are rare lesions that are typically fed by middle meningeal artery feeders and that drain via the sphenoparietal sinus or middle cerebral vein. We describe a unique case of a medial sphenoid wing fistula draining exclusively via the basal vein of Rosenthal.
  
  
  METHODS
  A 55-year-old man presented with progressive right temporal homonymous hemianopsia. Cerebral angiography revealed a DAVF that rapidly filled into the deep venous system via the basal vein of Rosenthal with a large venous varix compressing the optic nerve. The sphenoid wing DAVF was not amenable to endovascular embolization due to direct ophthalmic artery feeders and was therefore treated with surgical obliteration. A right pterional craniotomy with orbitozygomatic osteotomy was performed.
  
  
  RESULTS
  The fistula was clip ligated, and the venous varix was incised and drained. Intraoperative angiography demonstrated complete obliteration of the fistula.
  
  
  CONCLUSIONS
  Sphenoid wing DAVFs may drain via the deep venous system and have a complex arterial feeding network. Key features of the fistula, including deep venous drainage, presence of venous varices, and retrograde leptomeningeal venous drainage, make this an aggressive lesion with a high risk of rupture based on the available natural history data.
authors: Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA.
authors: Joshua W
authors: JW
authors: Osbun
authors: Louis J
authors: LJ
authors: Kim
authors: Robert F
authors: RF
authors: Spetzler
authors: Cameron G
authors: CG
authors: McDougall
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000503:physiopathology; D003399:Craniotomy; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery; D010027:Osteotomy; D013101:Sphenoid Sinus / Q000601:surgery*; D014786:Vision Disorders / Q000209:etiology; D015050:Zygoma / Q000601:surgery
keywords: Basal vein of Rosenthal; DAVF; Dural arteriovenous fistula; MMA; Middle meningeal artery; Skull base fistula; Vein of Galen; Venous varix