Sato Masanori, Nishimuta Yosuke, Moroki Koichi, Hanaya Ryosuke
Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences Department of Neurosurgery, Kagoshima, Japan
Neurosurgery, Kagoshima City Hospital, Kagoshima, Japan.
BMJ Case Rep. 2025 Apr 24;18(4):e265715. doi: 10.1136/bcr-2025-265715.
Sphenoid wing dural arteriovenous fistulae (DAVFs) are rare. Although the imaging findings of greater sphenoid wing DAVFs may resemble those of cavernous sinus DAVFs (CSDAVFs), their respective presentations differ. Benign CSDAVFs rarely convert to the aggressive type. Conversely, as greater sphenoid wing DAVFs are often of the aggressive type, with intracranial cortical venous reflux and varices, treatment is recommended. Sphenoid wing DAVFs tend to be of the non-sinus type, and transarterial embolisation is often an effective endovascular treatment. We present a case of an asymptomatic greater sphenoid wing DAVF mimicking a CSDAVF that converted from a non-aggressive sinus-type to an aggressive non-sinus-type due to compartmentalisation and thrombotic occlusion. Transarterial embolisation with Onyx and a transarterial venous coil resulted in complete disappearance of the DAVF. Greater sphenoid wing DAVFs can be misdiagnosed as CSDAVFs and require accurate imaging evaluation and careful follow-up, even in asymptomatic or non-aggressive cases.
蝶骨嵴硬脑膜动静脉瘘（DAVFs）较为罕见。尽管较大蝶骨嵴DAVFs的影像学表现可能与海绵窦DAVFs（CSDAVFs）相似，但其各自的表现有所不同。良性CSDAVFs很少转变为侵袭性类型。相反，由于较大蝶骨嵴DAVFs通常为侵袭性类型，伴有颅内皮质静脉反流和静脉曲张，因此建议进行治疗。蝶骨嵴DAVFs往往属于非海绵窦型，经动脉栓塞术通常是一种有效的血管内治疗方法。我们报告一例无症状的较大蝶骨嵴DAVF病例，其最初表现类似CSDAVF，因分隔和血栓性闭塞从非侵袭性海绵窦型转变为侵袭性非海绵窦型。使用Onyx进行经动脉栓塞和经动脉静脉弹簧圈栓塞导致DAVF完全消失。较大蝶骨嵴DAVFs可能被误诊为CSDAVFs，即使在无症状或非侵袭性病例中也需要进行准确的影像学评估和仔细随访。
