Challenges in Diagnosing and Treating Foramen Magnum Dural Arteriovenous Fistulas: A Case Study

Dural arteriovenous fistulas (DAVFs) represent a rare form of intracranial arteriovenous malformation, characterized by direct shunts between meningeal arteries and dural sinuses, dural veins, or cortical veins. DAVFs located in the foramen magnum (FM) region, including those involving the marginal sinus and condylar vein, exhibit complex arterial supply, diverse venous drainage patterns, and a range of clinical symptoms and associated risks. We present a case involving a 61-year-old male patient with a DAVF in the foramen magnum region, who clinically manifested limited abduction of the left eye and diminished visual acuity. Digital subtraction angiography (DSA) confirmed the presence of a DAVF in this region. Successful endovascular treatment, which included comprehensive cerebral angiography, was conducted under general anesthesia. Postembolization cerebral angiography demonstrated complete obliteration of the DAVF in the foramen magnum region, with no additional abnormalities observed. The patient experienced a favorable recovery and exhibited no subsequent neurological deficits. Diagnosing foramen magnum DAVFs is particularly challenging due to their nonspecific symptomatology, which frequently mimics more prevalent cervical or posterior cranial fossa disorders, potentially resulting in diagnostic delays or inaccuracies. This report aims to elucidate the clinical course, imaging findings, and therapeutic interventions in a patient with a foramen magnum DAVF, thereby offering valuable insights to enhance clinical suspicion, improve diagnostic accuracy, and facilitate timely management of this condition.