Percutaneous transvenous embolization of a dural arteriovenous fistula through a mastoid emissary vein

✓ Definitive endovascular treatment of dural arteriovenous fistulas (DAVFs) requires obliteration of the site of the fistula: either the diseased dural sinus or the pial vein. Access to this site is often limited by occlusion of the sinus proximal and distal to the segment containing the fistula. The authors describe a technique in which the mastoid emissary vein is used to gain access to a Borden–Shucart Type II DAVF in the transverse–sigmoid sinus. Recognition of this route of access, if present, may facilitate endovascular treatment of these lesions. Access to the transverse sinus via this approach can be straightforward and may be underused.

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Multiple Dural Arteriovenous Fistulas

Interventional Neuroradiology ◽

10.1177/159101990200800210 ◽

2002 ◽

Vol 8 (2) ◽

pp. 183-191 ◽

Cited By ~ 4

Author(s):

A.J.P. Goddard ◽

M.S. Khangure

Keyword(s):

De Novo ◽

Disease Process ◽

Venous Drainage ◽

Transverse Sinus ◽

Dural Sinus ◽

External Carotid ◽

Unique Case ◽

Arteriovenous Fistulas ◽

Type Iv ◽

Dural Arteriovenous Fistulas

Dural arteriovenous fistulas are most probably acquired lesions. However, they have been rarely encountered de novo. We present a unique case of a 71-year-old woman who initially presented with right-sided dural arteriovenous fistula (DAVF), which spontaneously resolved after diagnostic arteriography. She later developed asymptomatic occlusion of the left transverse sinus. Five years after her initial presentation she developed left-sided pulse-synchronous tinnitus. MRA and catheter angiography showed a complex type IV DAVF between the left transverse sinus and multiple dural branches arising from both left and right external carotid arteries. The left transverse sinus was isolated from the torcula herophili, with stenosis of the sigmoid sinus. Extensive cortical venous drainage was demonstrated. Endovascular cure was effected by polyvinyl alcohol particle and absolute alcohol occlusion of the dominant dural supply, and transvenous coil occlusion of the left transverse sinus. The patient's symptoms resolved almost immediately. This unique case demonstrates that dural sinus occlusion and DAVFs may co-exist, but there may not be a causal relationship. It is likely that both DAVFs and sinus occlusion are manifestations of the same disease process characterised by a pro-thrombotic state and secondary angiogenesis. It is important to recognise that changes in symptomatology, even long after apparent disappearance of a lesion may indicate recurrence, and careful follow up is advocated.

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Dural arteriovenous fistulas masquerading as dural sinus thrombosis

Journal of Neurosurgery ◽

10.3171/2008.7.jns08253 ◽

2009 ◽

Vol 110 (3) ◽

pp. 514-517 ◽

Cited By ~ 4

Author(s):

Scott Simon ◽

Tom Yao ◽

Arthur J. Ulm ◽

Benjamin P. Rosenbaum ◽

Robert A. Mericle

Keyword(s):

Sinus Thrombosis ◽

Noninvasive Imaging ◽

Anticoagulation Therapy ◽

Transverse Sinus ◽

Dural Sinus ◽

Dural Sinus Thrombosis ◽

Venous Flow ◽

Arteriovenous Fistulas ◽

Imaging Results ◽

Dural Arteriovenous Fistulas

The authors report dural sinus thrombosis diagnosed in 2 patients based on noninvasive imaging results, which were revealed to be dural arteriovenous fistulas (DAVFs) diagnosed using digital subtraction (DS) angiography. The first patient was a 63-year-old man who presented with headaches. Magnetic resonance venography was performed and suggested dural sinus thrombosis of the left transverse sinus and jugular vein. He was administered warfarin anticoagulation therapy but then suffered multiple intracranial hemorrhages. A DS angiogram was requested for a possible dural sinus thrombectomy, but the DS angiogram revealed a DAVF. The patient underwent serial liquid embolization with complete obliteration of the DAVF. The second patient, an 11-year-old boy, also presented with headaches and was diagnosed with dural sinus thrombosis on MR imaging. A DS angiogram was also requested for a possible thrombectomy and revealed a DAVF. This patient underwent serial liquid embolization and eventual operative resection. These reports emphasize that different venous flow abnormalities can appear similar on noninvasive imaging and that proper diagnosis is critical to avoid contraindicated therapies.

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Improvement of Depression after Treatment of Dural Arteriovenous Fistula: A Case Report and a Review

Case Reports in Psychiatry ◽

10.1155/2012/730151 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Minoru Nakagawa ◽

Kenji Sugiu ◽

Koji Tokunaga ◽

Chihoko Sakamoto ◽

Kenjiro Fujiwara

Keyword(s):

Arteriovenous Fistula ◽

Rare Case ◽

Dural Arteriovenous Fistula ◽

Sigmoid Sinus ◽

Local Hospital ◽

Emissary Vein ◽

Arteriovenous Fistulas ◽

Mastoid Emissary Vein ◽

Dural Arteriovenous Fistulas ◽

Gerstmann’S Syndrome

Patients with dural arteriovenous fistulas (DAVFs) in the transverse-sigmoid sinus suffer from several symptoms: bruit, headache, visual impairment, and so on. But depression is rare in patients with DAVF. The authors reported a rare case presenting the improvement of depression after the treatment of a dural arteriovenous fistula in the left transverse-sigmoid sinus. A 46-year-old male had suffered from depression and was treated with antidepressants at a local hospital for four years. The patient was temporarily laid off due to his depression. Afterwards, he had Gerstmann's syndrome and came to our hospital. A DAVF in the left transverse-sigmoid sinus was demonstrated on the angiogram. The DAVF was successfully treated with endovascular surgery, coil embolization of the isolated diseased sinus through the mastoid emissary vein which was a draining vein from the fistula. After this treatment, his depression as well as Gerstmann's syndrome was improved and the quantity of the antidepressants decreased. The patient returned to work without any antidepressant two years after the treatment. DAVFs might be one of the causes of depression. It may be necessary to evaluate cerebral vessels in patients suffering from depression by using MRA or 3D-CTA even if there are not any abnormal findings on plain CT scans.

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Transvenous Embolization via the Mastoid Emissary Vein in a Patient with Multiple Hemorrhagic Dural Arteriovenous Fistulas

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.cr.2016-0134 ◽

2017 ◽

Vol 11 (10) ◽

pp. 534-540 ◽

Cited By ~ 1

Author(s):

Hirofumi Iwahashi ◽

Atsushi Fujita ◽

Hirotomo Tanaka ◽

Mitsuru Ikeda ◽

Masashi Morikawa ◽

...

Keyword(s):

Transvenous Embolization ◽

Emissary Vein ◽

Arteriovenous Fistulas ◽

Mastoid Emissary Vein ◽

Dural Arteriovenous Fistulas

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An Onyx tunnel: reconstructive transvenous balloon-assisted Onyx embolization for dural arteriovenous fistula of the transverse-sigmoid sinus

Journal of Neurosurgery ◽

10.3171/2017.5.jns17287 ◽

2018 ◽

Vol 129 (4) ◽

pp. 922-927 ◽

Cited By ~ 5

Author(s):

Mena G. Kerolus ◽

Joonho Chung ◽

Stephen A. Munich ◽

Yoshikazu Matsuda ◽

Hideo Okada ◽

...

Keyword(s):

Treatment Option ◽

Balloon Catheter ◽

Transverse Sinus ◽

Sigmoid Sinus ◽

Dural Sinus ◽

Effective Treatment Option ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Complete Obliteration ◽

Technical Details

Transvenous embolization is an effective method for treating dural arteriovenous fistulas (DAVFs) of the transverse-sigmoid sinus (TSS). However, in cases of complicated DAVFs, it is difficult to preserve the patency of the dural sinus. The authors describe the technical details of a new reconstructive technique using transvenous balloon-assisted Onyx embolization as another treatment option in a patient with an extensive and complex DAVF of the left TSS.A microcatheter and compliant balloon catheter were navigated into the left internal jugular vein and placed at the distal end of the DAVF in the transverse sinus. The microcatheter was placed between the vessel wall of the TSS and the balloon. After the balloon was fully inflated, Onyx-18 was injected at the periphery of the balloon in a slow, controlled, progressive, stepwise manner; the balloon and microcatheter were simultaneously withdrawn toward the sigmoid sinus, with Onyx encompassing the entirety of the complex DAVF. The Onyx refluxed into multiple arterial feeders in a distal-to-proximal step-by-step manner, ultimately resulting in an Onyx tunnel. The final angiography study revealed complete obliteration of the DAVF and patency of the TSS.The Onyx tunnel, or reconstructive transvenous balloon-assisted Onyx embolization technique, may be an effective treatment option for large, complex DAVFs of the TSS. This technique may provide another option to facilitate the complete obliteration of the DAVF while preserving the functional sinus.

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Selective Transvenous Embolization for Dural Arteriovenous Fistulas with the Aid of Superselective Venograms of Fistulous Drainages and Involved Sinuses

Interventional Neuroradiology ◽

10.1177/15910199040100s105 ◽

2004 ◽

Vol 10 (1_suppl) ◽

pp. 43-50 ◽

Cited By ~ 1

Author(s):

M. Nakamura ◽

Y. Nakamura ◽

A. Fujita ◽

E. Kohmura

Keyword(s):

Developmental Process ◽

Sinus Thrombosis ◽

Transverse Sinus ◽

Dural Sinus ◽

Transvenous Embolization ◽

Arteriovenous Fistulas ◽

Sagittal Sinus ◽

Arteriovenous Shunts ◽

Dural Arteriovenous Fistulas ◽

Sinus Drainage

For the treatment of transvenous embolization (TVE) of dural arteriovenous fistulas (DAVFs) the sites of arteriovenous shunts, fistulous drainage, and the pathological changes inside the affected sinuses were explored in detail by means of preoperative arteriograms, superselective arteriograms, and superselective venograms. Out of 42 adult patients with DAVFs involving a total of 63 sinuses, three distinctive findings were identified as essential for indication of selective TVE for DAVFs. The first is extra-sinus fistulous drainage, which is embolizable fistulous drainage, remote from the major dural sinus, that flows into the sinus lumen. The second is intramural fistulous drainage, which is embolizable fistulous drainage located within the dural leafs of the involved sinus and separate from the major sinus lumen. The third consists of several lumens inside the affected sinuses, which suggests a variety of histological changes in the developmental process of sinus thrombosis and DAVFs. The extra-sinus drainage was occluded in three torcular heroplili fistulas and three transverse sinus fistulas. The intramural fistulous drainage was eliminated in three superior sagittal sinus fistulas. Several lumens inside the affected sinuses were encountered in 17 posterior fossa fistulas (68%) and 10 cavernous sinus fistulas (34%). These distinctive findings were recognized in 52% of the DAVFs. Out of various modalities for treatment of DAVFs, TVE has been the method of choice for the treatment of diffuse DAVFs. The TVE of DAVFs do not correspond to simple sinus occlusion, but imply selective occlusion of fistulous drainages and sinus lumens. The recognition of these three distinctive types of fistulous drainages have clinical impact in that it helps to completely occlude all the fistulous components of fistulas as well as preserve or restore the normal venous outflow through the involved sinus.

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Endovascular Treatment for Tentorial Dural Arteriovenous Fistulas

Surgery for Cerebral Stroke ◽

10.2335/scs.38.235 ◽

2010 ◽

Vol 38 (4) ◽

pp. 235-242 ◽

Cited By ~ 1

Author(s):

Naoko MIYAMOTO ◽

Isao NAITO ◽

Shin TAKATAMA ◽

Tomoyuki IWAI ◽

Masahiro MATSUMOTO ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

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Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽

10.1227/neu.0000000000000228 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S32-S41 ◽

Cited By ~ 19

Author(s):

Patrick P. Youssef ◽

Albert Jess Schuette ◽

C. Michael Cawley ◽

Daniel L. Barrow

Keyword(s):

Treatment Options ◽

Venous Drainage ◽

Venous Hypertension ◽

Surgical Approaches ◽

Dural Sinus ◽

Intraoperative Angiography ◽

Indocyanine Green Videoangiography ◽

Arteriovenous Fistulas ◽

The Past ◽

Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

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