DURAL ARTERIOVENOUS-FISTULA INVOLVING THE CAVERNOUS SINUS

Purpose Our purpose was to show how difficult it is to diagnose a dura l fistula of the cavernous sinus, which is an anomalous arteriovenous shunt within the dura mater extending from meningeal arteries to the c avernous sinus. Case report A dural fistula was suspected in four fema le patients aged between 61 and 80, presenting with a red eye, dilated episcleral veins, exophthalmos and elevated intraocular pressure. A c erebral hyperselective angiography was performed in all cases. Results The cerebral angiography confirmed the diagnosis of a dural fistula i n all cases, showing the early filling of the cavernous sinus followed by the draining vessel (posterior in case n degrees 4, anterior in ca ses n degrees 1, 2, 3). Case n degrees 2 was unilateral and cases n de grees 1, 3, 3 were bilateral. The blood flow was low in all cases. A s uccessful embolization was performed in all patients with resolution o f all symptoms. Conclusion The diagnosis of dural fistulas is often di fficult because of misleading clinical signs. It is documented by a ce rebral angiography showing the feeding vessels and helping to choose e ither venous or arterial embolization which is the most suitable treat ment.