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[Dural fistulae of the cavernous sinus and interventional neuroradiology. Apropos of 4 cases].

PURPOSE
Our purpose was to show how difficult it is to diagnose a dural fistula of the cavernous sinus, which is an anomalous arteriovenous shunt within the dura mater extending from meningeal arteries to the cavernous sinus.


CASE REPORT
A dural fistula was suspected in four female patients aged between 61 and 80, presenting with a red eye, dilated episcleral veins, exophthalmos and elevated intraocular pressure. A cerebral hyperselective angiography was performed in all cases.


RESULTS
The cerebral angiography confirmed the diagnosis of a dural fistula in all cases, showing the early filling of the cavernous sinus followed by the draining vessel (posterior in case n. 4, anterior in cases n degrees 1, 2, 3). Case n degrees 2 was unilateral and cases n. 1, 3, 3 were bilateral. The blood flow was low in all cases. A successful embolization was performed in all patients with resolution of all symptoms.


CONCLUSION
The diagnosis of dural fistulas is often difficult because of misleading clinical signs. It is documented by a cerebral angiography showing the feeding vessels and helping to choose either venous or arterial embolization which is the most suitable treatment.