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Case series
Endovascular management of torcular dural sinus malformations in children: the role of straight sinus occlusion
  1. Stanislas Smajda1,
  2. Michael Söderman2,3,
  3. Georg Dorfmüller4,
  4. Nathalie Dorison4,
  5. Marie-Claire Nghe5,
  6. Georges Rodesch6
  1. 1Interventional Neuroradiology, The Fondation Adolphe de Rothschild Hospital, Paris, France
  2. 2Neuroradiology, Karolinska Universitetssjukhuset, Stockholm, Sweden
  3. 3Karolinska Institutet Department of Clinical Neuroscience, Stockholm, Sweden
  4. 4Department of Pediatric Neurosurgery, The Fondation Adolphe de Rothschild Hospital, Paris, France
  5. 5Department of Anesthesiology and Intensive Care, The Fondation Adolphe de Rothschild Hospital, Paris, France
  6. 6Diagnostic and Interventional Neuroradiology Department, Hôpital Foch, Suresnes, France
  1. Correspondence to Dr Stanislas Smajda, Interventional Neuroadiology, The Fondation Adolphe de Rothschild Hospital, Paris 75019, France; stanis_s{at}hotmail.com

Abstract

Background Torcular dural sinus malformations (tDSMs) with arteriovenous shunts are rare congenital intracranial vascular malformations that carry a high rate of neurologic impairment and death in the neonatal, infant and young pediatric population. Their impact on brain venous drainage, especially the deep venous system, is one of the key factors in the clinical prognosis and natural history of the disease. We describe our therapeutic strategy for tDSMs, disconnecting the reflux into the deep venous system by performing an endovascular straight sinus occlusion.

Methods Among all children with dural sinus malformations seen between 2002 and 2020, we retrospectively reviewed those with tDSM in whom straight sinus occlusion had been performed.

Results Our databank included nine patients with tDSM that were embolized. Mean age at the clinical onset was 8.9±9.6 months (min–max=0–31). Five patients presented a significant reflux in the straight sinus on digital subtraction angiography. Those patients were initially clinically worse (mean modified Rankin Scale (mRS) 3.8) than those who did not present with reflux (mean mRS 2.25), this reflux being responsible for intraventricular hemorrhage in three patients. The reflux was suppressed by transarterial embolization in one patient and by transvenous straight sinus occlusion in four patients. Staged endovascular treatment resulted in a complete cure in six patients without complications, and clinical improvement in all patients.

Conclusion Straight sinus occlusion is a feasible technique that needs to be considered in the treatment strategy for tDSM with deep venous reflux in order to avoid or minimize brain damage.

  • congenital
  • fistula
  • vascular malformation
  • pediatrics
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Footnotes

  • Contributors SS and GR conceived the presented idea and wrote the manuscript. All authors were involved in the research. All authors discussed the results and contributed to the final manuscript.

  • 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 None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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