Rare sphenoid dural arteriovenous fistula treated with microsurgery: illustrative case

BACKGROUND: Dural arteriovenous fistula (DAVF) in the sphenoid region is a rare condition. It develops following aberrant vascular connections between arterial branches of the external and internal carotid arteries with sphenoidal venous drainage. The treatment can be endovascular embolization or open surgery to obliterate the fistula. OBSERVATIONS: A 62-year-old man was incidentally diagnosed with a DAVF located at the left lesser sphenoid wing during a routine checkup. Preoperative angiographic imaging revealed a high-grade fistula with arterial feeders originating from both the internal and external carotid arteries and venous drainage into the superficial middle cerebral vein (SMCV). Based on the angioarchitecture of the DAVF, surgery was performed, successfully obliterating the arterial feeders and disconnecting the fistula. LESSONS: The authors present an asymptomatic case of a left lesser sphenoid wing DAVF with an atypical venous drainage pattern involving the SMCV, sparing the cavernous sinus. Recognition of the vascular architecture and the high-grade nature of this vascular malformation is crucial for ensuring proper treatment and preventing serious complications. https://thejns.org/doi/10.3171/CASE2628.