Endovascular treatment of a bilateral ophthalmic-ethmoidal artery dural arteriovenous fistula.

A 76-year-old man developed blurred vision, and cerebral angiography disclosed an anterior skull base dural arteriovenous fistula (DAVF) supplied by both ethmoidal branches of the ophthalmic arteries and draining through a single cortical vein. Selective catheterization of both ophthalmic arteries distal to the origin of the central retinal arteries and occlusion the fistula feeders with injections of n-butyl cyanoacrylate glue led to complete occlusion of the fistula with preservation of retinal perfusion. The visual symptoms are attributed to impaired retinal perfusion as the result of a steal phenomenon. With care, a DAVF in this location can be successfully treated endovascularly while preserving retinal perfusion by embolizing the ophthalmic artery distal to the origin of the central retinal arteries and avoiding any backflow of embolizing material.