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AJNR - American Journal of Neuroradiology

Published ahead of print on September 26, 2007
doi: 10.3174/ajnr.A0717

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American Journal of Neuroradiology 28:1915-1918, November-December 2007
© 2007 American Society of Neuroradiology

Case Report
INTERVENTIONAL

Marginal Sinus Arteriovenous Fistulas Mimicking Carotid Cavernous Fistulas: Diagnostic and Therapeutic Considerations

R.D. Turner^a, V. Gonugunta^a, M.E. Kelly^a, T.J. Masaryk^a and D.J. Fiorella^a

^a From the Departments of Neurosurgery and Neuroradiology, Cleveland Clinic, Cleveland, Ohio

Please address correspondence to R. Turner, MD, Department of Neurological Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, S80, Cleveland, OH 44195; e-mail: turnerr{at}ccf.org

SUMMARY: Marginal sinus fistulas (MSFs) are uncommon vascular anomalies. Occasionally, the dominant venous drainage is forced retrograde up the inferior petrosal sinus and into the cavernous sinus, causing chemosis, proptosis, and ocular hypertension, mimicking a carotid cavernous fistula. This atypical clinical presentation may lead to misdiagnosis and inappropriate hazardous treatment of an MSF. Identifying the site of the fistula and understanding the anatomy of the venous drainage are critical in providing appropriate, safe, and efficacious endovascular treatment.