Bilateral Cavernous Dural Arteriovenous Fistula: Embolization with Unilateral Transvenous Approach

Background: Cavernous dural arteriovenous fistulas (CCFs) are rare vascular malformations that can lead to significant morbidity. This case illustrates a successful intervention for a patient with bilateral CCFs. Case Presentation: A 50-year-old male presented with a progressive headache over four months, accompanied by left proptosis and chemosis for one week. Clinical evaluation revealed a classic triad of symptoms: proptosis, chemosis, and orbital bruit, without neurological deficits. Imaging confirmed the presence of bilateral CCFs. Intervention: The patient underwent a unilateral transvenous embolization approach targeting both cavernous sinuses through the right anterior transvenous route. Embolization of the contralateral sinus was performed, followed by the ipsilateral sinus, utilizing a combination of endovascular techniques. Outcomes: Post-embolization angiography demonstrated complete occlusion of the CCFs, with significant resolution of ocular symptoms. The patient exhibited no complications, and clinical symptoms improved markedly. Conclusion: This case highlights the effectiveness of unilateral transvenous embolization in managing bilateral CCFs. Endovascular treatment remains the gold standard for symptomatic patients and offers a minimally invasive option with favorable outcomes. Keywords: Cavernous dural arteriovenous fistula, embolization, transvenous approach, endovascular treatment, vascular neurology.