Purpose To present trans-arterial venous sinus occlusion technique for dural arteriovenous fistulas of the transverse and sigmoid sinuses.
Materials and Methods Nine cases of dural arteriovenous sinus fistula of the transverse and sigmoid sinuses were treated with trans-arterial closure of the arterial supply and the venous sinus using ethylene vinyl alcohol copolymer (ONYX). Five patients were male and four were female. Age range was30–73. Patients presented with stroke, intracranial haemorrhage, seizure, headache or memory changes. Six patients had patent sinuses and three patients had fistulas involving isolated sinus segments which were Cognard IIa + b and Cognard IIb respectively. Criteria for selection for this treatment included complex multi-hole fistulas involving a broad surface of the sinus. External carotid artery branches could be directly embolised when considered safe. High risk arterial supply from ICA parenchymal vessels of the brain or ECA cranial nerve were embolised via retrograde collaterals. The affected venous sinus was a non-dominant or co-dominant sinus. Vein of Labbe had to be spared.
Results ONYX embolisation DAVF closure was accomplished in all nine patients with a total of 15 embolisation procedures. No cranial nerve neuropathies or strokes occurred related to arterial embolisation. No patients incurred strokes related to the venous sinus embolisation. DAVF closure was found to be durable at three months in eight patients with one patient pending follow up.
Conclusion Trans-arterial closure of transverse and sigmoid sinus provides an alternative to venous sinus coil occlusion, surgical skeletonization or radiosurgery. High risk arterial collaterals can be closed via artery-artery or artery-sinus-artery embolisation. In this small cohort, closure of dural AV fistulas was durable at three months with low complication rates.
Disclosures J. Rabinov: None. A. Yoo: None. T. Leslie-Mazwi: None. C. Ogilvy: None. J. Hirsch: None.
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