Lesser sphenoid wing dAVF (dural arteriovenous fistulas) are rare neurovascular lesions that require precise terminology to guide treatment. These complex fistulas primarily receive blood from the middle meningeal and ophthalmic arteries. Consequently, clinicians must understand the unique angioarchitecture of the sphenoparietal sinus to ensure clinical success and patient safety.

Effective Treatment of Lesser Sphenoid Wing dAVF

A recent review of cases highlights that microsurgery offers a more definitive cure than endovascular therapy. Specifically, surgeons achieved complete obliteration in 100% of microsurgical cases in the authors' series. In contrast, endovascular procedures faced a failure rate of nearly 67%. This high failure rate occurs because the anatomical features of these fistulas often prevent complete occlusion through a catheter. Furthermore, navigating the ophthalmic artery carries significant risks that specialists can avoid with open surgery.

Therefore, microsurgical management remains the preferred option for Borden type III fistulas in this region. Moreover, the bridging vein originating from the lesser wing typically serves as the primary drainage route. By using a direct surgical approach, specialists can ensure low morbidity and high success rates for their patients.

What is the primary treatment for Lesser Sphenoid Wing dAVF?

Microsurgical clip ligation is currently considered the most effective treatment. It provides direct access to the fistula and achieves a 100% occlusion rate in reported clinical series, significantly outperforming endovascular options.

Why does endovascular treatment often fail for these fistulas?

Endovascular therapy often fails due to the complex angioarchitecture and the risks associated with navigating the ophthalmic artery. The anatomical structure of the sphenoparietal sinus frequently results in incomplete occlusion when using endovascular techniques.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Serioli S et al. Rethinking the sphenoparietal sinus: implications for lesser sphenoid wing dural arteriovenous fistulas. Illustrative cases. J Neurosurg Case Lessons. 2026 May 18. doi: undefined. PMID: 42150199.

Fukuda H, et al. Endovascular treatment of sphenoid wing dural arteriovenous fistula with pure cortical venous drainage. J Stroke Cerebrovasc Dis. 2014;23(8):1730-1735.

Kandyba DV, et al. Dural arteriovenous fistula in the sphenoid bone lesser wing region: Endovascular adjuvant techniques and literature review. Interv Neuroradiol. 2018;24(5):559-566.