Transarterial and, to a lesser extent, transvenous embolizations are commonly used in the treatment of cerebral dural arteriovenous fistulas (dAVFs).1 When the feeding artery is small and tortuous, leading to difficult or impossible safe navigation and effective embolization, transvenous embolization may be a safe alternative.2 3 The efficacy of transvenous strategies relies on successful navigation of the draining vein up to the arterial–venous connection of the fistula (‘foot of the vein’). This strategy has been shown to be an effective way of treating otherwise inaccessible dAVFs with low morbidity and improved occlusion rates.4 We present the transvenous coil and Onyx (Medtronic, Minnesota, USA) embolization technique for a previously treated and recurrent dAVF involving tentorial feeders from the inferolateral trunk (video 1). It is a unique case in which counterflow navigation into the draining vein was achieved through the deep venous system via the right basal vein of Rosenthal, with the use of balloon intermittent flow arrest.
- Vascular Malformation
- Liquid Embolic Material
- Arteriovenous Malformation
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Contributors Acquisition of data: MC, PK. Drafting of the work and illustrations: MC. Critical revision of the work and final approval of the version to be published: MC, VMS, HS, PK. Conception and supervision of the work: PK.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PK is on the Editorial Board of JNIS.
Provenance and peer review Not commissioned; externally peer reviewed.