Dural Arteriovenous Fistula (D-AVF) With Ocular Proptosis: A Case Report

Faisal Budisasmita*, Ashari Bahar**, Muhammad Akbar**

*Neurology Resident on Department of Neurology Universitas Hasanuddin, Makassar, Indonesia
**Lecturer on Department of Neurology, Universitas Hasanuddin, Makassar, Indonesia

ABSTRACT

Introduction: The prevalence of intracranial dural arteriovenous fistulas (D-AVF) reported to be

10%-15% of all intracranial arteriovenous lesions. Some dural AVFs will give various ocular
symptoms including proptosis, diplopia, episcleral venous engorgement, periorbital swelling,
extraocular muscle limitation, visual field defect, and papillaedema.

Case: We reviewed five patients who had dural AVFs with ophthalmic manifestations in the past
three years (2016 to 2018) including 3 males and 2 females. The diagnosis of dural AVF was
confirmed by imaging, such as computed tomography scan (CT-Scan), head and neck computed
tomography arteriography/venography (CTA/V head and neck) and cerebral angiography.

According to Cognard’s classification, there were five types: type I, type II (a, b, a+b), type III, type
IV and type V. The early clinical manifestations including headache, diplopia, proptosis, episcleral
vein engorgement, periorbital swelling, visual field defect, and papillaedema. All patients received
transarterial embolization (TAE) in our hospital. Improvement in ophthalmic symptoms and signs
was noted after TAE treatment, although multiple interventions were required.

The dural AVF is composed of a nidus of abnormal arteries and veins with arteriovenous shunting
contained entirely within the sinus of the dura. Dural AVFs can exist in any sinus in the dura of the
intracranial cavity. In one stusdy, all patients with dural AVFs were classified according to two
grading scales: the more descriptive schema of Cognard et al and that recently proposed by Borden
et al. A correlation of clinical outcome was found between the Cognard and Borden classifications.

Conclusion: Dural AVFs can produce various ocular symptoms and signs at their initial
manifestation. The symptoms are believed to reflect venous hypertension in the superior sagital
sinus, resulting from the shunted flow, which interferes with normal venous drainage. Transarterial
embolization can be an effective treatment to close the fistula, restore sinus function and improve
ocular symptoms.

Key Words: dural arteriovenous fistula, transarterial embolization