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Tentorial dural arteriovenous fistula presenting with various visual symptoms related to anterior and posterior
Goetz Benndorf1, Stefanie Schmidt, Wolf-Peter Sollmann
1Department of Radiology, Charité, Humboldt University of Berlin, Berlin, Germany. g.benndorf@charite.de
Objective And Importance:
Dural arteriovenous fistulae (DAVFs) not directly shunting into the cavernous sinus are an infrequent cause of visual dysfunction. An unusual case of a tentorial DAVF associated with visual symptoms related to dysfunction of the anterior and posterior visual pathway is presented.
Clinical Presentation:
A 38-year-old woman with a history of long-standing bilateral proptosis experienced a sudden onset of headache and visual disturbances. Ocular examination revealed bilateral episcleral and retinal venous congestion, optic disc paleness, right superior homonymous quadrantanopsia in both eyes, and concentric narrowing of the visual field of the right eye. Angiography revealed a DAVF supplied by a falx branch arising from the left vertebral artery and both middle meningeal arteries, which drained directly into the markedly dilated vein of Galen via the basal vein of Rosenthal and the cavernous sinus into both superior ophthalmic veins.
Intervention:
Endovascular treatment was performed in two consecutive sessions by transarterial embolization with n-butylcyanoacrylate, which resulted in occlusion of the fistula and complete clinical cure, confirmed at the 6-month follow-up examination.
Conclusion:
Various neuro-ophthalmological findings may be caused by an arteriovenous lesion remote from the optic organ as a result of rerouting of venous drainage compromising the visual pathway at different locations. Transarterial embolization of a DAVF may result in complete cure if advantageous arterial anatomy allows for flow control and occlusion of the fistulous connection with liquid adhesives.