Transverse Sinus Dural Arteriovenous Fistula Presenting with Acute Hydrocephalus from Cerebellar Venous Engorgement Resolving with Endovascular Treatment

ABSTRACT Transarterial embolization (TAE) is a useful option for anterior cranial fossa–dural arteriovenous fistula (ACF–dAVF) as endovascular devices have progressed. Liquid agents are usually injected via a microcatheter positioned just proximal to the shunt pouch beyond the ophthalmic artery; however, high blood flow from the internal maxillary artery (IMA) often impedes penetration of embolic materials into the shunt pouch. Therefore, reducing blood flow from the IMA before embolization can increase the success rate. In the present case, to reduce blood flow from branches of the IMA, we inserted surgical gauze infiltrated with xylocaine and epinephrine into bilateral nasal cavities. Using this method, we achieved curative TAE with minimal damage to the nasal mucosa. Transnasal flow reduction is an easy, effective and minimally invasive method. This method should be considered in the endovascular treatment of ACF–dAVF, especially in patients with high blood flow from theIMA.

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Endovascular treatment of anterior cranial fossa dural arteriovenous fistula

Neuroradiology ◽

10.1007/s00234-007-0346-6 ◽

2008 ◽

Vol 50 (5) ◽

pp. 433-437 ◽

Cited By ~ 35

Author(s):

Xianli Lv ◽

Youxiang Li ◽

Zhongxue Wu

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Anterior Cranial Fossa ◽

Cranial Fossa

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Gradual dilatation of an occluded transverse sinus associated with dural arteriovenous fistula after balloon angioplasty with sinus packing: A case report

The Neuroradiology Journal ◽

10.1177/19714009211041529 ◽

2021 ◽

pp. 197140092110415

Author(s):

Takuya Osuki ◽

Hiroyuki Ikeda ◽

Tomoko Hayashi ◽

Silsu Park ◽

Minami Uezato ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Balloon Angioplasty ◽

Dural Arteriovenous Fistula ◽

Executive Dysfunction ◽

Venous Drainage ◽

Transverse Sinus ◽

Sigmoid Sinus ◽

Shunt Flow ◽

Symptomatic Epilepsy ◽

The Right

Background There is no consensus as to whether balloon angioplasty alone or stent placement is effective for sinus occlusion associated with dural arteriovenous fistula (DAVF). Herein, we first report a case of transverse sinus occlusion associated with DAVF in which gradual sinus dilatation was observed after balloon angioplasty with embolization of the affected sinus with shunt flow. Case presentation A 69-year-old man presented with executive dysfunction. Magnetic resonance imaging revealed left transverse sinus–sigmoid sinus DAVF with occlusion of the left jugular vein and right transverse sinus. Before endovascular treatment, the patient had symptomatic epilepsy and subarachnoid hemorrhage. Retrograde leptomeningeal venous drainage disappeared with packing of the left transverse sinus–sigmoid sinus. Subsequently, balloon angioplasty of the right occluded transverse sinus was performed to maintain the normal venous drainage and remaining shunt outflow. Dilatation of the right transverse sinus was poor immediately after surgery. However, angiography after 10 days and 6 months revealed gradual dilatation of the right transverse sinus. Conclusion Sinus occlusion, which is thought to be caused by sinus hypertension associated with DAVF rather than chronic organized thrombosis or thrombophilia, may dilate over time after balloon angioplasty and shunt flow reduction if occluded sinus is necessary for facilitating normal venous drainage.

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Endovascular Treatment of an Intracranial Dural Arteriovenous Fistula with Spinal Venous Drainage

Interventional Neuroradiology ◽

10.1177/159101999800400308 ◽

1998 ◽

Vol 4 (3) ◽

pp. 241-246 ◽

Cited By ~ 1

Author(s):

R. Cruz ◽

A. Stocker ◽

J. Xavier ◽

J. Almeida-Pinto

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Clinical Presentation ◽

Venous Drainage ◽

Hyperintense Signal ◽

Type V ◽

Progressive Paraparesis ◽

T2 Weighted Images

A case of type V intracranial dural arteriovenous fistula (DAVF) is reported because of its unusual rapidly progressive paraparesis. Despite this clinical presentation, the diagnosis of DAVF was made and precocious endovascular treatment was instituted. Angiographic normalization was obtained after embolisation and the patient significantly improved within the first weeks, although at the six month control MRI there still was a hyperintense signal of the cord in T2 weighted images, but less extensive than originally.

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Dural Arteriovenous Fistula at the Anterior Condylar Confluence

Interventional Neuroradiology ◽

10.1177/159101990801400311 ◽

2008 ◽

Vol 14 (3) ◽

pp. 303-312 ◽

Cited By ~ 33

Author(s):

S. Miyachi ◽

T. Ohshima ◽

T. Izumi ◽

T. Kojima ◽

J Yoshida

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Three Dimensional ◽

Drainage Pattern ◽

Hypoglossal Canal ◽

Shunt Occlusion ◽

Meningeal Arteries ◽

Anterior Condylar Vein ◽

Angiographic Findings

We reviewed the records of eight patients with a dural arteriovenous fistula (DAVF) close to the hypoglossal canal and determined the angioarchitecture of the clinical entity at the anterior condylar confluence. Eight patients with DAVF received endovascular treatment at our institute over the past five years. Imaging with selective three-dimensional angiography and thin-slice computed tomography were used to identify the fistula and evaluate the drainage pattern. Based on the angiographic findings, the ascending pharyngeal artery was the main feeder in all cases, and the occipital, middle meningeal, posterior auricular, and posterior meningeal arteries also supplied the DAVF to varying degrees. Contralateral contribution was found in five patients. The main drainage route was the external vertebral plexus via the lateral condylar veins in four patients, the inferior petrosal sinus in three patients, and the internal jugular vein via the connecting emissary veins in one patient. Selective angiography identified the shunt point at the anterior condylar confluence close to the anterior condylar vein. Shunt occlusion with transvenous coil packing was performed in all cases; transarterial feeder embolization was also used in three patients. Two patients treated with tight packing of the anterior condylar vein developed temporary or prolonged hypoglossal palsy. Based on our results, the main confluence of the shunt is located at the anterior condylar confluence connecting the anterior condylar vein and multiple channels leading to the extracranial venous systems. To avoid postoperative nerve palsy, the side of the anterior condylar vein in the hypoglossal canal should not be densely packed with coils. Evaluating the angioarchitecture using the selective three-dimensional angiography and tomographic imaging greatly helps to determine the target and strategy of endovascular treatment for these DAVF.

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