Skull Base Osseous Arteriovenous Fistula—A Rare Clinical Entity: Case Report and Literature Review
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Date
2016-11
Journal Title
Journal ISSN
Volume Title
Publisher
World Neurosurgery
Abstract
Purpose
To describe a rare clinical entity of intraosseous skull base arteriovenous fistula managed with transvenous fistula embolization.
Case Presentation
A 57-year-old woman presented with complaints of headache and episodic tinnitus with progressive left-sided visual deterioration. Cross-sectional imaging of the head revealed multiple vascular channels in the sphenoid bone and in bilateral masticator spaces. Catheter angiography showed the presence of a large osseous arteriovenous fistula epicentered in the body of sphenoid and left pterygoid plates with arterial feeders from bilateral external carotid arteries and venous drainage into bilateral cavernous sinuses and the pterygoid venous plexus. She was managed by transvenous coil and liquid embolic agent (Squid 18) embolization of the venous sac with significant reduction of shunt. In the postprocedure period, the patient developed paradoxical worsening of symptoms due to central retinal vein occlusion.
Conclusions
Skull base osseous fistulae are uncommon clinical entities and fistulae centered within the sphenoid bone are very rare. The aim of this report was to highlight management issues associated with such a case and review the available literature on the subject.
Description
Keywords
Central retinal vein occlusion; Osseous arteriovenous fistula; Skull base arteriovenous fistula; Transvenous embolization
Citation
Aneesh Mohimen, Santhosh Kumar, Jayadevan E R. Skull Base Osseous Arterio-venous fistula ? a rare clinical entity : Case report and Literature Review. World Neurosurgery. 2016