Cavernous Sinus Dural Arteriovenous Fistulas: General Aspects

Cavernous sinus (CS) dural arteriovenous fistulas (AVF), which are most common in middle-aged females, present with benign symptoms such as exophthalmos, chemosis, and orbital bruit. Benign CS dural AVF without cortical venous drainage (CVD) have the rare potential for development of CVD with neurological symptoms, even without treatment. On the other hand, aggressive type AVF with CVD can cause more aggressive symptoms such as cerebral hemorrhage. As symptoms are highly related to the drainage pattern, it is important to understand the anatomy of the CS itself, shunt point, and draining vein when treating the lesion. In general, the drainage route is gradually diminished by thrombosis and compartmentalization within the CS according to progression of the angiographical stage. At the restrictive stage, the disease is usually treated by endovascular treatment, particularly transvenous embolization.