Dural AV Fistula

Dural Arteriovenous Fistulas (D-AVF) With Ocular Proptosis: A Case Report
Faisal Budisasmita*, Ashari Bahar**, Muhammad Akbar**
*Neurology Resident on Department of Neurology Universitas Hasanuddin, Makassar, Indonesia
**Lecturer on Department of Neurology, Universitas Hasanuddin, Makassar, Indonesia
ABSTRACT
Introduction: The prevalence of dural arteriovenous fistulas (D-AVF) reported to be 10%-15% of
all intracranial arteriovenous lesions. Some D-AVF will give various ocular symptoms including
proptosis, diplopia, episcleral venous engorgement, periorbital swelling, extraocular muscle
limitation, visual field defect, and papillaedema.
Case: We reviewed five patients who had D-AVF with ophthalmic manifestations in the past three
years (2016 to 2018) including 3 males and 2 females. The diagnosis of D-AVF was confirmed by
imaging, such as computed tomography scan (CT-Scan), head and neck CT arteriography /
venography and cerebral angiography.
The early clinical manifestations including headache, diplopia, proptosis, episcleral vein
engorgement, periorbital swelling, visual field defect, and papillaedema. All patients received
transarterial embolization (TAE) in our hospital. Improvement in ophthalmic symptoms and signs
was noted after TAE treatment, although multiple interventions were required.
Conclusion: D-AVF can produce various ocular symptoms and signs at their initial manifestation.
The symptoms are believed to reflect venous hypertension in the cavernous sinus and ophthalmic
vein, resulting from the shunted flow, which interferes with normal venous drainage. Transarterial
embolization can be an effective treatment to close the fistula, restore sinus function and improve
ocular symptoms.
Key Words: dural arteriovenous fistula, transarterial embolization
Dural Arteriovenous Fistulas (D-AVF) Dengan Proptosis Mata: Laporan Kasus
Faisal Budisasmita *, Ashari Bahar **, Muhammad Akbar **
* Residen Neurologi Departemen Neurologi Universitas Hasanuddin, Makassar, Indonesia
** Dosen Departemen Neurologi, Universitas Hasanuddin, Makassar, Indonesia
ABSTRAK
Pendahuluan: Prevalensi fistula arteriovenous dural (D-AVF) intrakranial dilaporkan 10% -15%
dari semua lesi arteriovenous intrakranial. Beberapa D-AVF akan memberikan berbagai gejala
okular termasuk proptosis, diplopia, dilatasi vena episkleral, edema periorbital, keterbatasan
pergerakan otot ekstraokular, defek lapang pandang, dan edema papil.
Kasus: Kami meninjau lima pasien termasuk 3 pria dan 2 wanita yang memiliki D-AVF dengan
manifestasi mata dalam tiga tahun terakhir (2016 hingga 2018). Diagnosis D-AVF dikonfirmasi
dengan pencitraan, seperti computed tomography scan (CT-Scan), CT arteriografi / venografi
kepala dan leher dan angiografi serebral.
Manifestasi klinis awal termasuk sakit kepala, diplopia, proptosis, dilatasi vena episkleral, edema
periorbital, defek lapang pandang, dan edema papil. Semua pasien mendapatkan terapi embolisasi
transarterial (TAE) di rumah sakit kami. Perbaikan dalam gejala oftalmik dan tanda-tanda terlihat
setelah pengobatan TAE, meskipun beberapa jenis intervensi diperlukan.
Kesimpulan: D-AVF dapat mengakibatkan berbagai gejala dan tanda okular pada manifestasi
awal. Gejala diyakini sebagai akibat hipertensi vena pada sinus kavernous dan vena oftalmika, yang
diakibatkan dari aliran fistula yang terbentuk, yang mengganggu drainase vena yang normal.
Embolisasi transarterial dapat menjadi pengobatan yang efektif untuk menutup fistula,
mengembalikan fungsi sinus dan memperbaiki gejala okular.
Kata kunci: fistula arteriovenous dural, embolisasi transarterial