Cavernous Sinus Dural Arteriovenous Fistula with an Enhanced Lesion in the Brainstem Mimicking a Malignant Tumor.

Abstract

Cavernous sinus (CS) dural arteriovenous fistula (dAVF) with an enhanced lesion in the brainstem is rare, and an enhanced lesion in the brainstem might be indicative of irreversibility. A 77-year-old woman presented with double vision and ataxia. Magnetic resonance imaging showed a unilateral enhancement lesion in the pons, so a malignant brain tumor was suspected. A cerebral angiogram revealed CS-dAVF with retrograde leptomeningeal venous drainage (RLVD) to the brainstem. Transvenous embolization with selective coil embolization of RLVD was performed, and the symptoms and imaging improved dramatically. DAVFs with RLVD should be mentioned as a differential diagnosis of enhanced lesions in the brainstem. Transvenous embolization with selective coil embolization of RLVD was effective for the treatment of CS-dAVF, and a unilateral enhanced brainstem lesion may be reversible.