title: Ethmoidal dural arteriovenous fistula with unusual drainage route treated by transarterial embolization.
abstract: Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. In particular, this entity with reflux drainage directly into the ophthalmic vein is extremely rare. We report a case of ethmoidal dural AVF with direct drainage of the superior ophthalmic vein (SOV) and inferior ophthalmic vein (IOV), successfully treated by endovascular surgery. A 58-year-old man presented with progressive diplopia. Angiography and contrast-enhanced CT showed an ethmoidal dural AVF supplied via the bilateral anterior ethmoidal arteries and venous drainage through the left SOV and IOV. A transarterial approach through the bilateral anterior ethmoidal arteries was used to place the microcatheter close to the fistula site. After intra-arterial embolization with 20% N-butyl cyanoacrylate, the dural AVF was completely occluded. In patients with good vascular access, endovascular transarterial embolization may be an effective and less invasive treatment strategy for ethmoidal dural AVF.
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, Toon-shi, Ehime, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Inoue
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, Toon-shi, Ehime, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tagawa
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, Toon-shi, Ehime, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kumon
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, Toon-shi, Ehime, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Neurosurgery, Uwajima City Hospital, Uwajima-shi, Ehime, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shoda
authors.affiliation: Department of Neurosurgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugiu
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, Toon-shi, Ehime, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ohnishi
mesh_terms: D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000601:surgery; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005004:Ethmoid Bone / Q000098:blood supply; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome
keywords: CT Angiography; Fistula; Liquid Embolic Material; Vascular Malformation