Dural arteriovenous shunts in the region of the cavernous sinus

Abstract

Dural arteriovenous shunts in the region of the cavernous sinus probably account for most so-called spontaneous carotid-cavernous sinus fistulae. Eleven patients with this type of dural shunt were found in a review of 30 carotid cavernous-sinus fistulae. These shunts usually appear in middle-aged women as a distinctive syndrome. The signs usually are mild and include dilated conjunctival veins, proptosis, and bruit. Transient sixth-nerve palsy and unilateral headache frequently antedate orbital signs by many months. Spontaneous resolution is common.—Complete and selective cerebral angiography is essential for diagnosis. The dural shunt is usually one of low flow and low pressure, allowing normal opacification of intracranial arteries during carotid arteriography. Arterial contributions to these fistulae arise from meningcal branches of the internal and external carotid arteries. Terminal meningeal branches of the internal maxillary artery are the most common source of blood from the external carotid artery that supply the fistula. The most frequent source from the internal carotid artery is the meningo-hypophyseal trunk. Contributions from the contralateral dural vessels were frequently observed. The fistula is usually situated posteriorly in the cavernous sinus and, in most instances, venous drainage extends anteriorly into the ophthalmic veins.