Asian Journal of Neurosurgery

CASE REPORT
Year
: 2019  |  Volume : 14  |  Issue : 4  |  Page : 1268--1274

Spontaneous closure of a cavernous sinus dural arteriovenous fistula with spinal perimedullary drainage (Cognard V) during attempted transvenous embolization


Prasert Iampreechakul1, Korrapakc Wangtanaphat1, Punjama Lertbutsayanukul2, Yodkhwan Wattanasen2, Somkiet Siriwimonmas3 
1 Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand
2 Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand
3 Department of Radiology, Bumrungrad International Hospital, Bangkok, Thailand

Correspondence Address:
Dr. Prasert Iampreechakul
312 Rachawithi Road, Khwaeng Thung Phaya Thai, Bangkok 10400
Thailand

The authors describe a patient with spontaneous closure of a spontaneous cavernous sinus dural arteriovenous fistula (CSDAVF), Cognard type V, during transvenous attempt. A 39-year-old woman experienced mild proptosis, redness of the left eye, and diplopia. Four months later, she developed left retro-orbital pain and left-sided headache. Cerebral angiography revealed the left CSDAVF exclusively draining into the superior petrosal sinus with subsequent drainage into the veins surrounding the medulla oblongata, and finally into the perimedullary spinal veins, classified as Cognard type V. The feeders arise from the dural branches of both the left external and internal carotid arteries. Following 2 h period of attempted transvenous embolization, the fistula disappeared spontaneously. Follow-up angiography obtained 6 months later confirmed complete resolution of the CSDAVF. At 2-year follow-up, the patient has remained clinically asymptomatic. The mechanism of thrombosis in this fistula related to the endovascular procedure. We speculated that putting the wire tip in the draining vein may induce the spontaneous thrombosis in the venous side. In addition, precipitating factors may include small, low-flow fistula, and pre-existing thrombosis.


How to cite this article:
Iampreechakul P, Wangtanaphat K, Lertbutsayanukul P, Wattanasen Y, Siriwimonmas S. Spontaneous closure of a cavernous sinus dural arteriovenous fistula with spinal perimedullary drainage (Cognard V) during attempted transvenous embolization.Asian J Neurosurg 2019;14:1268-1274


How to cite this URL:
Iampreechakul P, Wangtanaphat K, Lertbutsayanukul P, Wattanasen Y, Siriwimonmas S. Spontaneous closure of a cavernous sinus dural arteriovenous fistula with spinal perimedullary drainage (Cognard V) during attempted transvenous embolization. Asian J Neurosurg [serial online] 2019 [cited 2020 Aug 11 ];14:1268-1274
Available from: http://www.asianjns.org/article.asp?issn=1793-5482;year=2019;volume=14;issue=4;spage=1268;epage=1274;aulast=Iampreechakul;type=0