• Kouichi Misaki, Naoyuki Uchiyama, Masanao Mohri, Yasuhiro Aida, Takehiro Uno, and Mitsutoshi Nakada.
• Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. Electronic address: misaki@med.kanazawa-u.ac.jp.
• World Neurosurg. 2017 Jan 1; 97: 753.e1-753.e5.

BackgroundDural arteriovenous fistulas (DAVFs) presenting with ocular symptoms, such as exophthalmos and chemosis, are commonly situated in the cavernous sinus (CS). DAVFs at the sphenoid wing with a drainage route into the superior orbital vein (SOV) should be considered as one of the differential diagnoses of ocular symptoms.Case DescriptionA 41-year-old woman presented with progressive left-sided chemosis and proptosis after left pulsating tinnitus that disappeared spontaneously. Cerebral angiography showed that the fistula was situated along the inferior edge of the superior orbital fissure on the greater sphenoid wing and drained solely into the SOV without flowing into the CS that caused ocular symptoms. Transvenous selective catheterization was performed via the facial vein and SOV. The fistula was then embolized using detachable coils.ConclusionsAfter embolization, the ocular symptoms resolved, and the patient was discharged without neurologic deficit. Herein, we discuss the developmental mechanism of the unique drainage pattern, including the clinical symptoms and anatomic features of greater sphenoid wing DAVFs.Copyright © 2016 Elsevier Inc. All rights reserved.

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