Ocular symptoms usually completely resolve after successful transvenous embolization of cavernous sinus
dural arteriovenous fistulas (CS-dAVFs). Herein, we report a case of CS-dAVF in which sinus packing of the superior ophthalmic vein (SOV) caused coil-induced
inflammation in orbital tissue, leading to deteriorating ocular symptoms. A 73-year-old woman presented with right-eye
exophthalmos and chemosis. Cerebral angiography demonstrated right CS-dAVF, which retrogradely drained into the right SOV. We conducted sinus packing with coils via the right inferior petrosal sinus, resulting in obliteration of the shunts. One day after sinus packing, right
exophthalmos and chemosis progressed, suggesting dAVF recurrence. However, no residual angiographic shunts were observed. Orbital magnetic resonance imaging (MRI) revealed
edema in intraorbital tissue and
gadolinium contrast enhancement of SOV wall. We presumed that the coils in SOV induced perifocal
inflammation at the venous wall and surrounding orbital tissue, leading to aggravation of ocular symptoms. Following
steroid therapy for 2 months, ocular symptoms and contrast enhancement on orbital MRI significantly improved without
anticoagulant treatment. Posttreatment paradoxical worsening of ocular symptoms could be caused by coil-induced
inflammation of the SOV wall near the orbital tissue.
Steroid therapy could be effective in reducing orbital inflammatory reactions.