case_images: PMC10408603_01
case_images: Head CT. Subcortical hemorrhage was confirmed.
case_images: SNI-14-232-g001.jpg
case_images: PMC10408603_01_SNI-14-232-g001.jpg
case_images: F1
case_images: She was transported with consciousness disturbance (Glasgow Coma Scale: E1V1M4) and seizure, and head computed tomography (CT) [Figure 1] showed a right frontal subcortical hemorrhage.
case_images: Digital subtraction angiography (DSA) and 3D-DSA (a). On external carotid angiography, the patient was diagnosed as cavernous sinus dural arteriovenous fistula, and the arrow head shows pseudo phlebitic pattern. The arrows show feeders; a: Middle meningeal artery, b: Artery of foramen rotundum, c: Accessory meningeal artery, and d: Ascending pharyngeal artery. DSA (b). On internal carotid angiography, inferior petrosal sinus was not visualized on venous phase. (c) CT venography. Inferior petrosal vein was not detected, and the arrow shows that facial vein was well visualized.
case_images: SNI-14-232-g002.jpg
case_images: PMC10408603_01_SNI-14-232-g002.jpg
case_images: F2
case_images: The feeders were middle meningeal artery (MMA), artery of foramen rotundum, accessory meningeal artery, and ascending pharyngeal artery (APA) [Figure 2a]. On angiography of internal carotid artery, IPS was not visualized [Figure 2b]. CT venography [CTV; Figure 2c] and contrast-enhanced magnetic resonance imaging did not show IPS.
case_images: Operative X-ray and digital subtraction angiography (DSA) (a). 7 Fr guiding catheter (arrow 1) was navigated to right internal jugular vein, and 4 Fr diagnostic catheter (arrow 2) was in right external carotid artery. Micro catheter (MC; arrow head a) and distal access catheter (DAC; arrow head b) was navigated to facial vein. MC (arrow head a) was navigated to superior middle cerebral vein superior ophthalmic vein (SOV) through, and DAC (arrow head b) was placed into SOV. DSA shows approach route, facial vein. (b) Coils which were showed in the circle were inserted, and cavernous sinus dural arteriovenous fistula was completely occluded.
case_images: SNI-14-232-g003.jpg
case_images: PMC10408603_01_SNI-14-232-g003.jpg
case_images: F3
case_images: Tokyo, Japan) was inserted into the right common femoral artery, and a 4 Fr diagnostic catheter was placed in the right external carotid artery for imaging as needed [Figure 3a]. The Guidepost 120 cm (outer diameter: 3.2 Fr, inner diameter: 0.035 inch; Tokai Medical Products, Kasugai, Japan) was used as a DAC, which provided high support even in a strongly bent and tortuous FV. The SL-10 catheter could be navigated to the SMCV by turning back the catheter through the CS [Figure 3a]. Six vessel studies were performed to confirm complete occlusion of the CSDAVF [Figure 3b].