Ophthalmic manifestations of intracranial dural arteriovenous fistula - Report of four cases

Objective: Intracranial dural arteriovenous fistulas (AVFs) account for 10%-15% of all intracranial arteriovenous lesions. Some dural AVFs produce ocular symptoms include proptosis, diplopia, episcleral venous engorgement, periorbital swelling, extraocular muscle limitation, visual field defect, and papillaedema. Materials and Methods: We reviewed four patients who had dural AVFs with ophthalmic manifestations in the past three years (2000 November to 2003 October.) The diagnosis of dural AVF was confirmed by image studies, such as magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and cerebral angiography. Results: There were three men and one woman. According to Cognard's classification, there were four types: type I, type II a, type II a+b, and type III. Symptoms at initial presentation included headache, diplopia, proptosis, episcleral vein engorgement, periorbital swelling, visual field defect, and papillaedema. Three patients received transarterial embolization (TAE) in our hospital. Improvement in ophthalmic symptoms and signs was noted after TAE treatment, although multiple interventions were required. Conclusions: Dural AVFs can produce various ocular symptoms and signs at their initial manifestation. The symptoms are believed to reflect venous hypertension in the superior sagital sinus, 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.