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Surgical Burr Hole Access for Direct Sinus Puncture and Transvenous Coil Embolization of a Complex Superior Sagittal Sinus Dural Arteriovenous Fistula
  1. Paz Kelmer1,
  2. Georgios S Sioutas2,
  3. Mohamed M Salem2,
  4. Visish M Srinivasan2,
  5. Jan Karl Burkhardt2
  1. 1Sheba Medical Center, Ramat Gan, Israel
  2. 2Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Paz Kelmer, Sheba Medical Center, Ramat Gan, Israel; pazkelmer92{at}


Dural arteriovenous fistulas (dAVFs) account for 10–15% of all cerebral vascular malformations,1 and their location around the superior sagittal sinus is rare with an incidence of 4–11% of all dAVFs.2 Endovascular transarterial or transvenous embolization are the treatment routes of choice for dAVFs,3 but in rare cases direct sinus access may be favorable.4 5 We present an unusual case of a complex superior sagittal sinus dAVF with multiple arterial feeders and an occluded posterior superior sagittal sinus segment which was challenging for classic embolization routes. A combined surgical and endovascular approach in the hybrid biplane operating room was performed and is shown in video 1. By using a direct surgical burr hole for sinus access anterior to the dAVF and the thrombosed sinus portion followed by transvenous coil embolization, the dAVF was cured in a minimally invasive and safe fashion.

Video 1 Treatment of a complex superior sagittal sinus dural arteriovenous fistula by surgical burr hole access for direct sinus puncture and transvenous coil embolization.

  • Arteriovenous Malformation
  • Venous Thrombosis
  • Intervention
  • Technique

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  • Contributors All authors have made substantial contributions to the work and approved the final version of the manuscript. Operating surgeon: JKB. Methodology: PK, GSS. Validation: GSS, MMS, VMS, JKB. Formal analysis: PK, GSS, MMS. Data curation: PK, GSS, SMM. Writing - original draft preparation: PK. Writing - review and editing: GSS, JKB. Visualization: PK, GSS, MMS. Supervision: JKB.

  • 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.

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