Spontaneous obliteration of a greater sphenoid wing dural arteriovenous fistula involving the diploic venous system.

Abstract

Background: Sphenoid wing dural arteriovenous fistulas (DAVFs) are rare vascular anomalies caused by abnormal arteriovenous shunting near the sphenoid bone. They are associated with significant risks, including cortical venous reflux and intracranial hemorrhage, especially when involving high-risk drainage pathways. Spontaneous regression of high-flow sphenoid wing DAVFs is exceedingly rare and has not been previously documented.

Case description: We report a 59-year-old woman with a history of head trauma who presented with progressive right eye proptosis, redness, blurred vision, and tinnitus over 5 months. Imaging revealed a high-flow sphenoid wing DAVF with drainage into the diploic venous system, superficial middle cerebral vein, and basal vein of Rosenthal. Angiography demonstrated venous outlet stenosis and preexisting thrombosis in the superior ophthalmic vein. While the patient was being prepared for endovascular treatment, follow-up imaging 6 months later confirmed spontaneous obliteration of the fistula, accompanied by complete resolution of symptoms.

Conclusion: This case highlights the unique occurrence of spontaneous regression in a high-flow sphenoid wing DAVF. The obliteration was likely facilitated by venous outlet stenosis, preexisting thrombosis, and the hemodynamic effects of contrast media during angiography. These findings emphasize the importance of careful monitoring and follow-up in the management of DAVFs, as spontaneous resolution, although rare, may occur.