case_images: PMC10559384_01
case_images: (a) Anteroposterior (AP) and (b) lateral views of the right external carotid artery injections show the right cavernous sinus dural arteriovenous fistula supplied from the right artery of the foramen rotundum, accessory meningeal artery, middle meningeal artery with drainage into the right superior ophthalmic vein (SOV), superior petrosal sinus and spinal medullary veins. There is partial filling of the right SOV (arrowheads) incompatible with the patient's ocular symptoms, probably representing pre-existing thrombosis. (c) AP and (d) lateral views of the right internal carotid artery (ICA) injections reveal the vascular supply from meningohypophyseal trunk (MHT). (e) AP view of the left ICA injection demonstrates the clival branch from the left MHT supplying the fistula.
case_images: SNI-14-307-g001.jpg
case_images: PMC10559384_01_SNI-14-307-g001.jpg
case_images: F1
case_images: In addition, drainage was through the right lateral medullary veins into the dilated spinal perimedullary veins, corresponding with a classification of a Cognard type V DAVF [Figure 1].
case_images: Lateral views of the right (a) accessory meningeal artery and (b) middle meningeal artery injections before embolization. During glue embolization from the right (c) accessory meningeal artery and (d) middle meningeal artery. (e) Anteroposterior (AP) and (f) lateral views of the right external carotid artery and (g) AP and (h) lateral views of the right internal carotid artery injections demonstrate incomplete obliteration of the fistula.
case_images: SNI-14-307-g002.jpg
case_images: PMC10559384_01_SNI-14-307-g002.jpg
case_images: F2
case_images: Therefore, transarterial embolization with N-butyl cyanoacrylate (NBCA) through the right accessory and meningeal arteries was performed with the result of incomplete obliteration of the fistula [Figure 2].
case_images: Cerebral angiography obtained 6 months after embolization. (a) Anteroposterior (AP) and (b) lateral views of the right external carotid artery, (c) AP and (d) lateral views of the right internal carotid artery (ICA), and (e) AP view of the left ICA injections confirms complete obliteration of the right cavernous sinus dural arteriovenous fistula.
case_images: SNI-14-307-g003.jpg
case_images: PMC10559384_01_SNI-14-307-g003.jpg
case_images: F3
case_images: Six months following endovascular treatment, cerebral angiography was obtained and demonstrated the disappearance of the fistula [Figure 3].
case_images: PMC10559384_02
case_images: (a) Anteroposterior (AP) and (b) lateral views of the right external carotid artery and (c) AP and (d) lateral views of the right internal carotid artery (ICA) injections show the right cavernous sinus dural arteriovenous fistula supplied from the right artery of the foramen rotundum, accessory meningeal artery, middle meningeal artery, and meningohypophyseal trunk (MHT) with drainage into the right dilated superficial middle cerebral and Labbe veins. There is no drainage into the right superior ophthalmic vein incompatible with the patient's ocular symptoms, probably representing pre-existing thrombosis. (e) AP view of the left ICA injection demonstrates the clival branch from the left MHT supplying the fistula.
case_images: SNI-14-307-g004.jpg
case_images: PMC10559384_02_SNI-14-307-g004.jpg
case_images: F4
case_images: Cerebral angiography showed the right CSDAVF fed by the right artery of the foramen rotundum, accessory meningeal artery, MMA, and dural branches of the bilateral cavernous segment of ICAs with drainage into the right dilated superficial middle cerebral and Labbe veins, corresponding with a classification of a Cognard type IIb DAVF [Figure 4].
case_images: (a) Anteroposterior (AP) and (b) lateral views of the right accessory meningeal artery injection show the right cavernous sinus dural arteriovenous fistula with drainage into the right dilated superficial middle cerebral and Labbe veins. (c) AP and (d) lateral views during Onyx injection. (e) AP and (f) lateral views of the right external carotid artery injection reveal incomplete obliteration of the fistula.
case_images: SNI-14-307-g005.jpg
case_images: PMC10559384_02_SNI-14-307-g005.jpg
case_images: F5
case_images: CS. Control angiography after embolization demonstrated incomplete obliteration of the fistula [Figure 5].
case_images: Cerebral angiography obtained 6 months after embolization. (a) Anteroposterior (AP) and (b) lateral views of the right external carotid artery, (c) AP and (d) lateral views of the right internal carotid artery (ICA), and (e) AP view of the left ICA injections reveal complete regression of the right cavernous sinus dural arteriovenous fistula.
case_images: SNI-14-307-g006.jpg
case_images: PMC10559384_02_SNI-14-307-g006.jpg
case_images: F6
case_images: Another session of embolization was scheduled, and cerebral angiography obtained 4 months later revealed complete regression of the fistula [Figure 6].