Four-dimensional digital subtraction angiography for exploration of intraosseous arteriovenous fistula in the sphenoid bone

Toshihiro Ishibashi; Fumiaki Maruyama; Issei Kan; Tohru Sano; Yuichi Murayama

doi:10.25259/SNI_858_2020

Four-dimensional digital subtraction angiography for exploration of intraosseous arteriovenous fistula in the sphenoid bone

Surg Neurol Int. 2021 Mar 2:12:85. doi: 10.25259/SNI_858_2020. eCollection 2021.

Authors

Toshihiro Ishibashi¹, Fumiaki Maruyama¹, Issei Kan¹, Tohru Sano¹, Yuichi Murayama¹

Affiliation

¹ Department of Neurosurgery, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.

Abstract

Background: Intraosseous arteriovenous fistula (AVF) is a rare clinical entity that typically presents with symptoms from their effect on surrounding structures. Here, we report a case of intraosseous AVF in the sphenoid bone that presented with bilateral abducens palsy.

Case description: A previously healthy man presented with tinnitus for 1 month, and initial imaging suspected dural AVF of the cavernous sinus. Four-dimensional digital subtraction angiography (4D-DSA) imaging and a three-dimensional (3D) fused image from the bilateral external carotid arteries revealed that the shunt was in a large venous pouch within the sphenoid bone that was treated through transvenous coil embolization. His symptoms improved the day after surgery.

Conclusion: This is a case presentation of intraosseous AVF in the sphenoid bone and highlights the importance of 4D-DSA and 3D fused images for planning the treatment strategy.

Keywords: Dural arteriovenous fistula; Four-dimensional digital subtraction angiography; Intraosseous; Neuroendovascular; Sphenoid bone.

Publication types

Case Reports