Dural Arteriovenous Fistula in the Anterior Cranial Fossa with Feeder from the Ophthalmic Artery: 4 Cases Report Were Treated with Endovascular Treatment

Abstract

Background: Dural arteriovenous fistula (DAVF) in the anterior cranial fossa is rare with 5% compared to intracrainal DAVF, but the risk of cerebral hemorrhage is higher than in other locations. DAVF in anterior fossa usually has a feeder from the ethmoidal branch of the ophthalmic artery and therefore transarterial embolization must be possible to occlude the fistula site and preserve the central retinal artery. So, our study aims to evaluate the efficacy and safety of endovascular treatment for DAVF in the anterior acranial fossa with feeder from ophthalmic artery.
Methods: Retrospective study with 4 cases of DAVF anterior cranial fossa who received endovascular treatment at Cho Ray Hospital from 1/2021 to 1/2024. Clinical and imaging characteristics were assessed before intervention, at discharge, and at 3-month follow-up.
Results: These cases had the common characteristics of being hospitalized because of low vision, 1 case of cerebral hemorrhage and 1 case of bulging eyes. CT/MRI confirmed that the feeder artery was from the ethmoid branch of the ophthalmic artery with large dilatation of venous drainage. Endovascular treatment approached the ophthalmic artery in 4 cases, of which 1 case had to approach the bilateral ophthalmic arteries, 1 case had to approach the meningeal branch of the external carotid artery. Technical success with complete occlusion of the fistula site and preservation of the central retinal artery in all cases. The microcatheters used were microcatheter detachable tip in 3 cases, Onyx 18 embolic agent was used in all cases. Procedural complications related to 1 case was invasive onyx into the superior sagittal sinus, however the limitaion was small and did not affect the flow of the vein. Followed up after 90 days of treatment, no recurrence was noted, and vision improved significantly in 3/4 cases.

Conclusion: Transarterial embolization with approach from the ophthalmic artery in DAVF anterior cranial fossa is a reasonable, safe and effective treatment that have high capable of occluding the fistula site and preserving the central retinal artery.