Abstract
OBJECTIVE: Moyamoya disease and dural arteriovenous fistulas (dAVFs) are both rare conditions, and their coexistence is extremely uncommon. The causal relationship between moyamoya disease and cavernous sinus dAVFs (CS-dAVFs) remains unclear. We report a successfully treated case of CS-dAVF in a patient with moyamoya disease, focusing on vascular structural changes and potential pathophysiological associations. CASE PRESENTATION: A 69-year-old man with a history of moyamoya disease presented with progressive left ocular symptoms. Imaging studies, including 3D-DSA, revealed a CS-dAVF supplied by multiple feeders and draining into the superior ophthalmic and angular veins. Compared to previous imaging, the progression of moyamoya disease was evident, with worsening middle cerebral artery stenosis and increased collateral vessels. Superselective transvenous embolization was performed under general anesthesia. Microcatheters were navigated into the affected venous structures, and coil embolization successfully obliterated the shunt. Postoperatively, the patient had significant symptomatic improvement, with no moyamoya-related complications, and was discharged on postoperative day 4. CONCLUSION: To our knowledge, this is the first report of a successfully treated CS-dAVF in a patient with moyamoya disease. Superselective transvenous embolization was successfully performed, which led to a favorable outcome despite the presence of moyamoya disease.