Periorbital edema due to ophthalmic vein stenosis in cavernous sinus dural arteriovenous fistula embolization via middle temporal vein: a case report

Abstract Introduction Embolization via the transvenous route is an established treatment for cavernous sinus (CS) dural arteriovenous fistula (DAVF). Among transvenous approaches, the trans-middle temporal vein (MTV)-superior ophthalmic vein (OphV) route is less commonly employed but represents a viable alternative. However, associated superior OphV stenosis can result in postoperative periorbital swelling secondary to impaired venous drainage. A rare case of this complication is reported. Case presentation A 71-year-old woman presented with a two-month history of swelling and redness in the right eye. One month earlier, she had undergone an unsuccessful transvenous embolization through the inferior petrosal sinus. On examination, swelling of the upper eyelid and conjunctival congestion were noted in the right eye. Under general anesthesia, angiography revealed a CS DAVF with MTV drainage. The trans-MTV-OphV procedure was subsequently performed. A 6 F supporting catheter was placed in the right brachiocephalic vein, followed by successful advancement of a 4.6 F distal access catheter into the MTV. The arterial roadmap demonstrated a stenotic superior OphV. A microcatheter was then navigated through the stenotic OphV and advanced to the origin of the OphV, where coiling and Onyx casting achieved complete obliteration of the DAVF. Postoperatively, the patient developed periorbital swelling secondary to stenosis and impairment of the OphV. Prednisolone (500 mg once daily) was administered for three days, leading to the resolution of the periorbital swelling. Conclusion In cases of CS DAVF, the trans-MTV-superior OphV approach may represent a viable venous access alternative. However, superior OphV stenosis can result in postoperative periorbital swelling, resulting in impaired venous drainage. Glucocorticoid therapy may be effective in managing this complication.