PMC5961284_01
(a and b) Three-dimensional time-of-flight MR angiography (a, axial view and b, sagittal view) reveals high signal in the superior orbital fissure (arrow) to the SOV and the IOV. The high signal is continuous with the cavernous sinus (double arrows) posterior to the superior orbital fissure
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F1
The three-dimensional time-of-flight magnetic resonance (MR) angiography identified a high-intensity signal in the left SOV and the inferior ophthalmic vein (IOV) [Figure 1].
(a) The left internal carotid artery angiography (ICAG) reveals an arteriovenous fistula between the ILT of the internal carotid artery and the SOV. (b) Shunting blood flow drains from the SOV to the facial vein through the angular vein and not into the cavernous sinus. (c) In the venous phase of the ICAG, the cavernous sinus is revealed as normal intracranial venous return pathway (lateral view)
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F2
The left cavernous sinus was used as the antegrade intracranial venous return pathway in the venous phase of the DSA [Figure 2].
A 4-Fr intermediate catheter (Cerulean; arrow) is placed in the left facial vein. A microcatheter (Renegade; the first marker: arrowhead; the second marker: double arrows) is placed near the shunting point in the superior orbital fissure (lateral view)
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F3
We embolized the SOV using nine detachable coils (Orbit Galaxy 3-8 mm, Codman; Target nano 2-3 mm, Stryker) [Figure 3].
(a) The common carotid artery angiography (CCAG) after coil embolization exhibits complete obliteration of the arteriovenous fistula. (b) The venous phase of the CCAG demonstrates the antegrade venous flow in the left cavernous sinus (lateral view)
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F4
ILT and the MMA was completely occluded. In the venous phase of the angiography, the left cavernous sinus was maintained as the antegrade pathway of the cerebral venous return [Figure 4].