Multifocal Dural Arteriovenous Fistula Formation Following Successful Endovascular Treatment of a Traumatic Direct Carotid Cavernous Fistula

The development of dural arteriovenous fistulas (DAVFs) following treatment of a direct carotid-cavernous fistula (CCF) is extremely rare. We report the first case of multifocal DAVF formation at distinct anatomical sites after direct CCF treatment. A 76-year-old woman underwent successful endovascular therapy for a traumatic right-sided direct CCF. One month post-embolization, angiography revealed DAVFs at the left cavernous sinus and right inferior petrosal sinus. The left cavernous sinus DAVF was treated with transvenous embolization, while the asymptomatic right inferior petrosal sinus DAVF underwent spontaneous regression. Clinicians should maintain long-term vigilance following direct CCF treatment, as multiple DAVFs may develop at distant anatomical sites.