A Patient with a Cavernous Sinus Dural Arteriovenous Fistula in Whom Direct Puncture of the Superior Ophthalmic Vein Led to Rapidly Progressing Thrombosis and Postoperative Non-arteritic Ischemic Optic Neuropathy: Pathogenesis with Respect to a Drainage Route

Objective: We report a patient in whom direct puncture of the superior ophthalmic vein for a cavernous sinus dural arteriovenous fistula led to rapidly progressing thrombosis and postoperative non-arteritic ischemic optic neuropathy (NA-ION), and review the pathogenesis. Case Presentation: A 74-year-old female. Detailed examination of diplopia and visual disorder suggested a cavernous sinus dural arteriovenous fistula. As approaching via a posterior route was difficult, transvenous embolization by direct puncture of the superior ophthalmic vein was performed. As drainage routes were aggregated around this vein, thrombosis of this vein occurred, inducing postoperative NA-ION through a rapid change in hemodynamics. Conclusion: When performing direct puncture of the superior ophthalmic vein, puncture methods and heparinization should be considered after sufficiently investigating drainage routes.