• Aneesh Mohimen, Santhosh Kumar Kannath, and E R Jayadevan.
• Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Kerala, India. Electronic address: romianeesh@gmail.com.
• World Neurosurg. 2017 Jan 1; 97: 760.e9-760.e12.

PurposeTo describe a rare clinical entity of intraosseous skull base arteriovenous fistula managed with transvenous fistula embolization.Case PresentationA 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.ConclusionsSkull 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.Copyright © 2016 Elsevier Inc. All rights reserved.

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