Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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October 1, 2012
Indirect Dural Arteriovenous Fistula of Left Cavernous Sinus
- Patient's presentation is most suggestive of dural arteriovenous fistula of the left cavernous sinus. Other differential considerations include carotico-cavernous fistula, acute exacerbation of glaucoma, orbital cellulitis, and retrobulbar hemorrhage, all less likely with this presentation.
- Cognard type 2a transverse sinus dural arteriovenous fistula (dAVF) would not typically present this way. In this case, the internal jugular venous outflow obstruction (due to thrombosis) likely caused redirection of flow towards the cavernous sinus with consequent orbital hypertension.
- Type 2a dAVF do not necessarily require treatment, but for this patient, therapy was indicated because vision was threatened.
- Transarterial and transvenous therapies are available. We chose a transvenous disconnection of the cavernous sinus from the arterialized transverse and sigmoid sinuses to convert the Cognard type 2a fistula to a Cognard type 1 fistula.