title: Unique Venous Drainage of a Sphenoid Wing Dural Arteriovenous Fistula with Ocular Symptoms.
abstract: BACKGROUND
  Dural arteriovenous fistulas (DAVFs) presenting with ocular symptoms, such as exophthalmos and chemosis, are commonly situated in the cavernous sinus (CS). DAVFs at the sphenoid wing with a drainage route into the superior orbital vein (SOV) should be considered as one of the differential diagnoses of ocular symptoms.
  
  
  METHODS
  A 41-year-old woman presented with progressive left-sided chemosis and proptosis after left pulsating tinnitus that disappeared spontaneously. Cerebral angiography showed that the fistula was situated along the inferior edge of the superior orbital fissure on the greater sphenoid wing and drained solely into the SOV without flowing into the CS that caused ocular symptoms. Transvenous selective catheterization was performed via the facial vein and SOV. The fistula was then embolized using detachable coils.
  
  
  CONCLUSIONS
  After embolization, the ocular symptoms resolved, and the patient was discharged without neurologic deficit. Herein, we discuss the developmental mechanism of the unique drainage pattern, including the clinical symptoms and anatomic features of greater sphenoid wing DAVFs.
authors: Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. Electronic address: misaki@med.kanazawa-u.ac.jp.
authors: Kouichi
authors: K
authors: Misaki
authors: Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Naoyuki
authors: N
authors: Uchiyama
authors: Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Masanao
authors: M
authors: Mohri
authors: Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Yasuhiro
authors: Y
authors: Aida
authors: Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Takehiro
authors: T
authors: Uno
authors: Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Mitsutoshi
authors: M
authors: Nakada
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D002550:Cerebral Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D003229:Conjunctival Diseases / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D003937:Diagnosis, Differential; D004487:Edema / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D004621:Embolization, Therapeutic / Q000379:methods*; D005094:Exophthalmos / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
keywords: Dural arteriovenous fistula; Greater sphenoid wing; Superior orbital vein; Target coil embolization; Transvenous embolization; Venous thrombus