Worsening of cavernous sinus dural arteriovenous fistula with incomplete superior ophthalmic thrombosis after palliative transarterial embolization.

ABSTRACT

Worsening of ocular symptoms in cavernous sinus dural arteriovenous fistulae (CSDAVF) is rarely due to superior ophthalmic vein (SOV) thrombosis after palliative transarterial embolization and may resolve spontaneously. We present a unique case of a 38-year-old female whose ocular symptoms worsened three days after palliative embolization. Repeat angiography revealed incomplete thrombus of SOV and severe orbital venous congestion. Complete occlusion of the CSDAVF was achieved by urgent transvenous embolization through the SOV and the patient's ocular symptoms and visual impairment recovered. In such situations repeat angiogram may be needed in evaluating the subtle angiographic changes and curative embolization may be necessary.