Reversible Abducens Nerve Palsy Following Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistula

Sohn, Jong Hee; Choi, Hui Chul; Lee, Sang Moo; Sheen, Seung Hun

doi:2009.13.1.53

Ann Geriatr Med Res > Volume 13(1); 2009 > Article

Case Report

Journal of the Korean Geriatrics Society 2009;13(1):53-56.
DOI: https://doi.org/10.4235/jkgs.2009.13.1.53 Published online March 31, 2009.

Reversible Abducens Nerve Palsy Following Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistula

Jong Hee Sohn, Hui Chul Choi, Sang Moo Lee, Seung Hun Sheen

¹Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea. dohchi@hallym.or.kr
²Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea.

해면정맥동 경막동정맥루의 경정맥색전술 이후에 발생한 가역적 외전신경마비

Abstract

Transvenous embolization has become the treatment of choice for cavernous sinus dural arteriovenous fistula(cDAVF). However, there are potential complications associated with this procedure such as cranial nerve palsies and venous perforations. A 66-year-old woman presented with a 2-week left periorbital swelling and conjunctival injection. Brain MRI showed engorgement of the left superior ophthalmic vein. Cerebral angiography revealed a dural arteriovenous shunt of the cavernous sinus with retrograde venous drainage into the superior ophthalmic vein. Her proptosis and conjunctival injection resolved completely after transvenous embolization of cDAVF. However, an abducens nerve palsy developed the day after the procedure, which, fortunately, resolved spontaneously. She was symptom-free at the follow- up evaluation 2 months later. The abducens nerve palsy related to the transvenous embolization of cDAVF was presu- med due to either dense packing of the sinus, venous thrombosis, or direct nerve injury. We report a case of transient abducens nerve palsy associated with transvenous embolization of cDAVF, suggesting the benign course of this com- plication.

Key Words: Cavernous sinus, Central nervous system vascular malformations, Abducens nerve diseases

초 록

66세 여자 환자가 2주 전부터 시작된 좌측 눈의 결막충혈과 안구돌출을 주소로 입원하였다. 입원 당일 시행한 뇌자기공명영상촬영에서 좌측위비스듬근 위에 팽창된 상안 정맥이 관찰되었고, 다음날 시행한 뇌혈관 조영술에서 내경동맥의 아래뇌하수체동맥과 외경동맥의 내상악동맥의 분지가 해면정맥동으로 많은 수의 루를 형성하고 있었다. 경정맥 색전술 후 결막충혈과 안구돌출 증상은 즉시 호전되었으나, 다음날 좌측외전신경마비가 발생되었다. 특별한 치료없이 경과 관찰하였으며, 2달 후 증상은 저절로 회복되었다. 저자들은 경막동정맥루의 치료를 위한 경정맥색전술 이후에 발생한 가역적 외전신경마비를 경험하여 이를 문헌고찰과 함께 보고하는 바이다.