Dural Arteriovenous Fistula of the Cavernous Sinus following Tolosa-Hunt Syndrome

DOI 5 References
  • Hirai Nozomi
    Department of Neurosurgery, Toho University Ohashi Medical Center
  • Saito Norihiko
    Department of Neurosurgery, Toho University Ohashi Medical Center
  • Hayashi Morito
    Department of Neurosurgery, Toho University Ohashi Medical Center
  • Yokosako Suguru
    Department of Neurosurgery, Toho University Ohashi Medical Center
  • Iwama Junya
    Department of Neurosurgery, Toho University Ohashi Medical Center
  • Sato Ken-ichiro
    Department of Neurosurgery, Toho University Ohashi Medical Center
  • Aoki Kazuya
    Department of Neurosurgery, Toho University Ohashi Medical Center
  • Iizuka Yuo
    Department of Radiology, Toho University Ohashi Medical Center
  • Fujii Yoshiki
    Mitaka-Nakamura Neurosurgical Clinic
  • Iwabuchi Satoshi
    Department of Neurosurgery, Toho University Ohashi Medical Center

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Other Title
  • Tolosa-Hunt症候群と診断後, 海綿静脈洞部硬膜動静脈瘻を発症した1例

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  A 77-year-old woman was referred to our hospital by a primary care physician for further evaluation of oculomotor paralysis. We diagnosed Tolosa-Hunt syndrome and prescribed prednisolone 30 mg/day, after which her symptoms improved. Approximately 1 year after the onset of Tolosa-Hunt syndrome, she presented with abducens paralysis and ocular hyperemia, and a bruit was heard in her right orbit.<br>  Findings from cerebral angiography indicated a diagnosis of cavernous sinus dural arteriovenous fistula. Her condition required immediate medical attention, and we thus performed endovascular coil embolization by microcatheter insertion into the right cavernous sinus via the bilateral inferior petrosal sinuses. After the procedure, the bruit disappeared and her abducens paralysis and ocular hyperemia improved. A cerebral angiogram 6 months after the procedure confirmed the disappearance of the cavernous sinus dural arteriovenous fistula. The precise cause of intracranial dural arteriovenous fistulas has not been determined, although secondary factors such as inflammation, trauma, surgery, tumors, previous infections, and sinus thrombosis have all been implicated in the past.<br>  We hypothesize that in this instance, inflammation that remained due to inadequate prednisolone dosing induced the cavernous sinus dural arteriovenous fistula in our patient.<br>  Correct diagnosis and adequate treatment of Tolosa-Hunt syndrome are important. In addition, the careful evaluation of patients with a history of Tolosa-Hunt syndrome may aid in diagnosing cavernous sinus dural arteriovenous fistula.

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