A case of sigmoid sinus dural arteriovenous fistula after treated cavernous dural arteriovenous fistula.

Transvenous embolization has been recommended recently as the primary treatment for symptomatic cavernous dural arteriovenous fistula (dural AVF). We present a case of sigmoid sinus dural AVF which developed after transvenous embolization of cavernous dural AVF. A 43-year-old man was admitted to our hospital because of left conjunctivill chemosis, exophthalmus and abducens nerve palsy. Cerebral angiograms showed left cavernous dural AVF fed by the bilateral internal and external carqtid arteries and draining into the enlarged left superior ophthalmic vein. Transfemoral approach in the cqvernous sinus via inferior petrosal sinus (IPS) was difficult because of the occlusive change of IPS. Then, direct canulation of the left superior ophthalmic vein and transvenous embolization using interlocking detachable coils (IDC) were performed. Dural AVF and clinical symptoms were disappeard rapidly after embolization. Six months later, follow-up cerebral angiograms showed development of a dural AVF in the left sigmoid sinus. The pathogenesis of dural AVF remains unclear. We suggest that injury to the sinus wall during endovascular procedures may have provoked the development of dural AVF in our case. Clinical and angiographical follow-up are important.