Selective transvenous liquid embolization of a Type 1 dural arteriovenous fistula at the junction of the transverse and sigmoid sinuses

Case report

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✓ The authors describe the case of a 51-year-old man with a Type 1 dural arteriovenous fistula (AVF) located at the junction of the transverse and sigmoid sinuses. The dural AVF developed after the patient underwent a craniotomy for an acute extradural hematoma. The patient suffered pulsatile tinnitus 3 months after surgery. After several attempts at transarterial embolization (TAE), the venous channel located close to the skull fracture was accessed via a transfemoral—transvenous approach and was embolized by administering a liquid nonadhesive agent. Successful embolization of the dural AVF was achieved both clinically and radiologically without causing considerable hemodynamic alterations. This procedure, either alone or combined with TAE, would seem to be an alternative treatment for dural AVFs in this location, without causing compromise of flow within the affected sinuses, when selective venous access is available.

Article Information

Address reprint requests to: Kazuhiro Ohtakara, M.D., Department of Neurosurgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. email: pingouin@nyc.odn.ne.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Preoperative CT scan showing an extradural hematoma in the right temporoparietal region. Center: Postoperative T2-weighted MR image demonstrating the right temporal lobe as a high intensity area, consistent with contusion. Right: Postoperative three-dimensional CT scan revealing a linear fracture crossing the junction of the right transverse and sigmoid sinuses (arrows). The craniotomy site in the neighborhood of the right transverse and sigmoid sinuses is also seen (arrowheads).

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    Angiographic studies. Upper Left: Right CCA injection (lateral projection) revealing a dural AVF draining antegradely into the junction of the right transverse and sigmoid sinuses; the lesion is supplied by the OA. Upper Right: Right ECA injection obtained at a site distal from the origin of the OA (lateral view) revealing that the dural AVF is also fed by the middle meningeal and superficial temporal arteries as well as by the PAA. Lower Left: Right ICA injection (lateral view) demonstrating that the dural AVF is supplied by the lateral tentorial artery of the meningohypophyseal trunk and the temporal branches of the middle cerebral artery. Lower Right: Left VA injection obtained after the initial transarterial embolization (frontal projection) disclosing that the dural AVF is fed by the temporal branches of the right posterior cerebral artery.

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    Angiogram obtained after selective injection of the venous conduit via a transsinus retrograde route (lateral projection) demonstrating only retrograde filling of the venous channel and the dural veins converging on the channel. Note the tip of the microcatheter, placed in a transsinus direction in the venous conduit (arrows). Platinum coils deposited in the right OA and PAA are also seen.

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    Follow-up angiographic studies obtained 3 months after TVE. Right CCA (lateral projection [left]) and left VA (frontal projection [center]) injections revealing complete obliteration of the fistula. Right CCA injection (frontal projection [right]) demonstrating no flow compromise of the affected sinuses or the cortical veins.

References

  • 1.

    Arnautovíc KIAl-Mefty OAngtuaco Eet al: Dural arteriovenous malformations of the transverse/sigmoid sinus acquired from dominant sinus occlusion by a tumor: report of two cases. Neurosurgery 42:3833881998Arnautovíc KI Al-Mefty O Angtuaco E et al: Dural arteriovenous malformations of the transverse/sigmoid sinus acquired from dominant sinus occlusion by a tumor: report of two cases. Neurosurgery 42:383–388 1998

    • Search Google Scholar
    • Export Citation
  • 2.

    Awad IALittle JRAkrawi WPet al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:8398501990Awad IA Little JR Akrawi WP et al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:839–850 1990

    • Search Google Scholar
    • Export Citation
  • 3.

    Barnwell SLHalbach VVDowd CFet al: A variant of arteriovenous fistulas within the wall of the dural sinuses. Results of combined surgical and endovascular therapy. J Neurosurg 74:1992041991Barnwell SL Halbach VV Dowd CF et al: A variant of arteriovenous fistulas within the wall of the dural sinuses. Results of combined surgical and endovascular therapy. J Neurosurg 74:199–204 1991

    • Search Google Scholar
    • Export Citation
  • 4.

    Borden JAWu JKShucart WA: A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82:1661791995Borden JA Wu JK Shucart WA: A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82:166–179 1995

    • Search Google Scholar
    • Export Citation
  • 5.

    Chaudhary MYSachdev VPCho SHet al: Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR 3:13191982Chaudhary MY Sachdev VP Cho SH et al: Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR 3:13–19 1982

    • Search Google Scholar
    • Export Citation
  • 6.

    Cloft HJKallmes DFJensen MEet al: Percutaneous transvenous coil embolization of a type 4 sagittal sinus dural arteriovenous fistula: case report. Neurosurgery 41:119111941997Cloft HJ Kallmes DF Jensen ME et al: Percutaneous transvenous coil embolization of a type 4 sagittal sinus dural arteriovenous fistula: case report. Neurosurgery 41:1191–1194 1997

    • Search Google Scholar
    • Export Citation
  • 7.

    Cognard CGobin YPPierot Let al: Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with revised classification of venous drainage. Radiology 194:6716801995Cognard C Gobin YP Pierot L et al: Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with revised classification of venous drainage. Radiology 194:671–680 1995

    • Search Google Scholar
    • Export Citation
  • 8.

    Cognard CHoudart ECasasco Aet al: Long-term changes in intracranial dural arteriovenous fistulae leading to worsening in the type of venous drainage. Neuroradiology 39:59661997Cognard C Houdart E Casasco A et al: Long-term changes in intracranial dural arteriovenous fistulae leading to worsening in the type of venous drainage. Neuroradiology 39:59–66 1997

    • Search Google Scholar
    • Export Citation
  • 9.

    Dawson RC IIIJoseph GJOwens DSet al: Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and sigmoid sinuses. AJNR 19:5715761998Dawson RC III Joseph GJ Owens DS et al: Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and sigmoid sinuses. AJNR 19:571–576 1998

    • Search Google Scholar
    • Export Citation
  • 10.

    Djindjian RMerland JJTheron J: Superselective Arteriography of the External Carotid Artery. Berlin: Springer-Verlag1978 pp 405406Djindjian R Merland JJ Theron J: Superselective Arteriography of the External Carotid Artery. Berlin: Springer-Verlag 1978 pp 405–406

    • Search Google Scholar
    • Export Citation
  • 11.

    Endo SKuwayama NTakaku Aet al: Direct packing of the isolated sinus in patients with dural arteriovenous fistulas of the transverse-sigmoid sinus. J Neurosurg 88:4494561998Endo S Kuwayama N Takaku A et al: Direct packing of the isolated sinus in patients with dural arteriovenous fistulas of the transverse-sigmoid sinus. J Neurosurg 88:449–456 1998

    • Search Google Scholar
    • Export Citation
  • 12.

    Feldman RAHieshima GGiannotta SLet al: Traumatic dural arteriovenous fistula supplied by scalp, meningeal, and cortical arteries: case report. Neurosurgery 6:6706741980Feldman RA Hieshima G Giannotta SL et al: Traumatic dural arteriovenous fistula supplied by scalp meningeal and cortical arteries: case report. Neurosurgery 6:670–674 1980

    • Search Google Scholar
    • Export Citation
  • 13.

    Fermand MReizine DMelki JPet al: Long term follow-up of 43 pure dural arteriovenous fistulae (AVF) of the lateral sinus. Neuroradiology 29:3483531987Fermand M Reizine D Melki JP et al: Long term follow-up of 43 pure dural arteriovenous fistulae (AVF) of the lateral sinus. Neuroradiology 29:348–353 1987

    • Search Google Scholar
    • Export Citation
  • 14.

    Gobin YPHoudart ERogopoulos Aet al: Percutaneous transvenous embolization through the thrombosed sinus in transverse sinus dural fistula. AJNR 14:110211051993Gobin YP Houdart E Rogopoulos A et al: Percutaneous transvenous embolization through the thrombosed sinus in transverse sinus dural fistula. AJNR 14:1102–1105 1993

    • Search Google Scholar
    • Export Citation
  • 15.

    Goto KSidipratomo POgata Net al: Combining endovascular and neurosurgical treatments of high-risk dural arteriovenous fistulas in the lateral sinus and the confluence of the sinuses. J Neurosurg 90:2892991999Goto K Sidipratomo P Ogata N et al: Combining endovascular and neurosurgical treatments of high-risk dural arteriovenous fistulas in the lateral sinus and the confluence of the sinuses. J Neurosurg 90:289–299 1999

    • Search Google Scholar
    • Export Citation
  • 16.

    Halbach VVHigashida RTHieshima GBet al: Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology 163:4434471987Halbach VV Higashida RT Hieshima GB et al: Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology 163:443–447 1987

    • Search Google Scholar
    • Export Citation
  • 17.

    Halbach VVHigashida RTHieshima GBet al: Transvenous embolization of dural fistulas involving transverse and sigmoid sinuses. AJNR 10:3853921989Halbach VV Higashida RT Hieshima GB et al: Transvenous embolization of dural fistulas involving transverse and sigmoid sinuses. AJNR 10:385–392 1989

    • Search Google Scholar
    • Export Citation
  • 18.

    Hamada YGoto KInoue Tet al: Histopathological aspects of dural arteriovenous fistulas in the transverse-sigmoid sinus region in nine patients. Neurosurgery 40:4524581997Hamada Y Goto K Inoue T et al: Histopathological aspects of dural arteriovenous fistulas in the transverse-sigmoid sinus region in nine patients. Neurosurgery 40:452–458 1997

    • Search Google Scholar
    • Export Citation
  • 19.

    Hayama NSugiura KBaba Met al: [Traumatic dural arteriovenous malformation. Case report.] Neurol Med Chir 26:8118151986 (Jpn)Hayama N Sugiura K Baba M et al: [Traumatic dural arteriovenous malformation. Case report.] Neurol Med Chir 26:811–815 1986 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 20.

    Hoh BLChoudhri TFConnolly ES Jret al: Surgical management of high-grade intracranial dural arteriovenous fistulas: leptomeningeal venous disruption without nidus excision. Neurosurgery 42:7968051998Hoh BL Choudhri TF Connolly ES Jr et al: Surgical management of high-grade intracranial dural arteriovenous fistulas: leptomeningeal venous disruption without nidus excision. Neurosurgery 42:796–805 1998

    • Search Google Scholar
    • Export Citation
  • 21.

    Houser OWCampbell JKCampbell RJet al: Arteriovenous malformation affecting the transverse dural venous sinus—an acquired lesion. Mayo Clin Proc 54:6516611979Houser OW Campbell JK Campbell RJ et al: Arteriovenous malformation affecting the transverse dural venous sinus—an acquired lesion. Mayo Clin Proc 54:651–661 1979

    • Search Google Scholar
    • Export Citation
  • 22.

    Kallmes DFJensen MECloft HJet al: Percutaneous transvenous coil embolization of a Djindjian type 4 tentorial dural arteriovenous malformation. AJNR 18:6736761997Kallmes DF Jensen ME Cloft HJ et al: Percutaneous transvenous coil embolization of a Djindjian type 4 tentorial dural arteriovenous malformation. AJNR 18:673–676 1997

    • Search Google Scholar
    • Export Citation
  • 23.

    Lalwani AKDowd CFHalbach VVet al: Grading venous restriction disease in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus. J Neurosurg 79:11151993Lalwani AK Dowd CF Halbach VV et al: Grading venous restriction disease in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus. J Neurosurg 79:11–15 1993

    • Search Google Scholar
    • Export Citation
  • 24.

    Lawton MTJacobowitz RSpetzler RF: Redefined role of angiogenesis in the pathogenesis of dural arteriovenous malformations. J Neurosurg 87:2672741997Lawton MT Jacobowitz R Spetzler RF: Redefined role of angiogenesis in the pathogenesis of dural arteriovenous malformations. J Neurosurg 87:267–274 1997

    • Search Google Scholar
    • Export Citation
  • 25.

    Link MJCoffey RJNichols DAet al: The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. J Neurosurg 84:8048091996Link MJ Coffey RJ Nichols DA et al: The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. J Neurosurg 84:804–809 1996

    • Search Google Scholar
    • Export Citation
  • 26.

    Mironov A: Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR 19:3893911998Mironov A: Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR 19:389–391 1998

    • Search Google Scholar
    • Export Citation
  • 27.

    Morita AMeyer FBNichols DAet al: Childhood dural arteriovenous fistulae of the posterior dural sinuses: three case reports and literature review. Neurosurgery 37:119312001995Morita A Meyer FB Nichols DA et al: Childhood dural arteriovenous fistulae of the posterior dural sinuses: three case reports and literature review. Neurosurgery 37:1193–1200 1995

    • Search Google Scholar
    • Export Citation
  • 28.

    Mullan S: Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae. J Neurosurg 80:6066161994Mullan S: Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae. J Neurosurg 80:606–616 1994

    • Search Google Scholar
    • Export Citation
  • 29.

    Nabors MWAzzam CJAlbanna FJet al: Delayed postoperative dural arteriovenous malformations. Report of two cases. J Neurosurg 66:7687721987Nabors MW Azzam CJ Albanna FJ et al: Delayed postoperative dural arteriovenous malformations. Report of two cases. J Neurosurg 66:768–772 1987

    • Search Google Scholar
    • Export Citation
  • 30.

    Nakahara SKatoh Y: [A case of posttraumatic vascular abnormality similar to dural arteriovenous malformation.] No Shinkei Geka 14:137113751986 (Jpn)Nakahara S Katoh Y: [A case of posttraumatic vascular abnormality similar to dural arteriovenous malformation.] No Shinkei Geka 14:1371–1375 1986 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 31.

    Nishijima MTakaku AEndo Set al: Etiological evaluation of dural arteriovenous malformations of the lateral and sigmoid sinuses based on histopathological examinations. J Neurosurg 76:6006061992Nishijima M Takaku A Endo S et al: Etiological evaluation of dural arteriovenous malformations of the lateral and sigmoid sinuses based on histopathological examinations. J Neurosurg 76:600–606 1992

    • Search Google Scholar
    • Export Citation
  • 32.

    Piton JGuilleux MHGuibert-Tranier Fet al: Fistulae of the lateral sinus. J Neuroradiol 11:1431591984Piton J Guilleux MH Guibert-Tranier F et al: Fistulae of the lateral sinus. J Neuroradiol 11:143–159 1984

    • Search Google Scholar
    • Export Citation
  • 33.

    Roy DRaymond J: The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40:113311441997Roy D Raymond J: The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40:1133–1144 1997

    • Search Google Scholar
    • Export Citation
  • 34.

    Sadato ANumaguchi YTaki Wet al: Nonadhesive liquid embolic agent: role of its components in histologic changes in embolized arteries. Acad Radiol 5:1982061998Sadato A Numaguchi Y Taki W et al: Nonadhesive liquid embolic agent: role of its components in histologic changes in embolized arteries. Acad Radiol 5:198–206 1998

    • Search Google Scholar
    • Export Citation
  • 35.

    Sakaki TMorimoto TNakase Het al: Dural arteriovenous fistula of the posterior fossa developing after surgical occlusion of the sigmoid sinus. Report of five cases. J Neurosurg 84:1131181996Sakaki T Morimoto T Nakase H et al: Dural arteriovenous fistula of the posterior fossa developing after surgical occlusion of the sigmoid sinus. Report of five cases. J Neurosurg 84:113–118 1996

    • Search Google Scholar
    • Export Citation
  • 36.

    Sasaki THoya KKinone Ket al: Postsurgical development of dural arteriovenous malformations after transpetrosal and transtentorial operations: case report. Neurosurgery 37:8208251995Sasaki T Hoya K Kinone K et al: Postsurgical development of dural arteriovenous malformations after transpetrosal and transtentorial operations: case report. Neurosurgery 37:820–825 1995

    • Search Google Scholar
    • Export Citation
  • 37.

    Sundt TM JrPiepgras DG: The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 59:32391983Sundt TM Jr Piepgras DG: The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 59:32–39 1983

    • Search Google Scholar
    • Export Citation
  • 38.

    Terada THigashida RTHalbach VVet al: Development of acquired arteriovenous fistulas in rats due to venous hypertension. J Neurosurg 80:8848891994Terada T Higashida RT Halbach VV et al: Development of acquired arteriovenous fistulas in rats due to venous hypertension. J Neurosurg 80:884–889 1994

    • Search Google Scholar
    • Export Citation
  • 39.

    Urtasun FBiondi ACasaco Aet al: Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization. Radiology 199:2092171996Urtasun F Biondi A Casaco A et al: Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization. Radiology 199:209–217 1996

    • Search Google Scholar
    • Export Citation
  • 40.

    Watanabe ATakahara YIbuchi Yet al: Two cases of dural arteriovenous malformation occuring after intracranial surgery. Neuroradiology 26:3753801984Watanabe A Takahara Y Ibuchi Y et al: Two cases of dural arteriovenous malformation occuring after intracranial surgery. Neuroradiology 26:375–380 1984

    • Search Google Scholar
    • Export Citation
  • 41.

    Yamashita KTaki WIwata Het al: A cationic polymer, Eudragit-E, as a new liquid embolic material for arteriovenous malformations. Neuroradiology 38 (Suppl 1):S151S1561996Yamashita K Taki W Iwata H et al: A cationic polymer Eudragit-E as a new liquid embolic material for arteriovenous malformations. Neuroradiology 38 (Suppl 1):S151–S156 1996

    • Search Google Scholar
    • Export Citation

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