Reversible Abducens Nerve Palsy Following Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistula

ABSTRACT

Transvenous embolization has become the treatment of choice for cavernous sinus dural arteriovenous fistula(cDAVF). However, there are potential complications associated with this procedure such as cranial nerve palsies and venous perforations. A 66-year-old woman presented with a 2-week left periorbital swelling and conjunctival injection. Brain MRI showed engorgement of the left superior ophthalmic vein. Cerebral angiography revealed a dural arteriovenous shunt of the cavernous sinus with retrograde venous drainage into the superior ophthalmic vein. Her proptosis and conjunctival injection resolved completely after transvenous embolization of cDAVF. However, an abducens nerve palsy developed the day after the procedure, which, fortunately, resolved spontaneously. She was symptom-free at the follow- up evaluation 2 months later. The abducens nerve palsy related to the transvenous embolization of cDAVF was presu- med due to either dense packing of the sinus, venous thrombosis, or direct nerve injury. We report a case of transient abducens nerve palsy associated with transvenous embolization of cDAVF, suggesting the benign course of this com- plication.