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Case report
A single burr hole approach for direct transverse sinus cannulation for the treatment of a dural arteriovenous fistula
  1. Justin M Caplan1,
  2. Ian Kaminsky2,
  3. Philippe Gailloud2,
  4. Judy Huang1
  1. 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Division of Neurointerventional Radiology, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr J M Caplan, Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower, Room 6007, Baltimore, MA 21287, USA; justincaplan{at}jhmi.edu

Abstract

A 55-year-old woman with a symptomatic Borden II/Cognard IIa+b transverse sinus dural arteriovenous fistula underwent an attempted percutaneous transvenous embolization which was ultimately not possible given the fistula anatomy. She then underwent a partial percutaneous transarterial embolization but the fistula recurred. Given the failed percutaneous interventions, the patient underwent a combined open surgical/transvenous embolization using neuronavigation and a single burr hole craniectomy. She has remained symptom free for 3 months. This case report illustrates the feasibility of combining minimally invasive open surgical access to allow for direct venous cannulation for endovascular embolization of a dural arteriovenous fistula when traditional percutaneous methods are not an option.

  • Angiography
  • Brain
  • Coil
  • Fistula
  • Navigation

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