Sir,

Stereotactic gamma knife radiosurgery is proposed as a safe, less-invasive and effective treatment for low-flow dural arteriovenous fistula of cavernous sinus (DAVFCS).1 With the integration of the stereotactic angiographic and magnetic resonance (MR) imaging results during radiation dose planning, gamma knife radiosurgery imposes minimal damage to the adjacent vital structures.2 Progressive occlusion of the fistula may impose less haemodynamic impact to the cerebral vascular network compared to endovascular treatment. We report a case of paradoxical worsening of symptoms and signs with superior ophthalmic vein (SOV) thrombosis and central retinal vein occlusion (CRVO) after gamma knife radiosurgery before complete obliteration of the fistula. The MR images depict the mechanism of this phenomenon.

Log in or create a free account to read this content

Gain free access to this article, as well as selected content from this journal and more on nature.com

Access through your institution

or

Sign in or create an account
Continue with Google
Continue with ORCiD