Transfemoral, transvenous embolisation of dural arteriovenous fistula involving the isolated transverse-sigmoid sinus from the contralateral side

Acta Neurochir (Wien). 2002 Oct;144(10):1041-6; discussion 1046. doi: 10.1007/s00701-002-0997-3.


Background: A dural arteriovenous fistula (AVF) involving the transverse-sigmoid (T-S) sinus which is occluded at its proximal and distal ends i.e., an isolated sinus, runs the risk of haemorrhaging or causing serious neurological deficits as a result of its retrograde leptomeningeal venous drainage. While lesions of this type have not been considered to be treatable by percutaneous, transvenous embolisation, this paper challenges this view.

Case presentation: Two middle-aged men with dural AVFs involving the isolated left T-S sinus presented with motor aphasia due to focal brain edema or haemorrhage. Under local anaesthesia, transfemoral, transvenous embolisation was performed with a microcatheter that was passed through the occluded proximal transverse sinus from the right (contralateral) side. The isolated sinus was then occluded with platinum coils. This embolisation resulted in angiographic and clinical cure of dural AVFs in both patients.

Interpretation: Transfemoral, transvenous embolisation is a therapeutic alternative for the treatment of dural AVFs involving the isolated T-S sinus. Embolisation obviates the need for craniotomy and general anaesthesia, which are required for the established modes of treatment, i.e., direct surgery or direct percutaneous sinus packing.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Angiography, Digital Subtraction
  • Brain Edema / diagnostic imaging
  • Brain Edema / therapy
  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Central Nervous System Vascular Malformations / therapy*
  • Cerebral Angiography
  • Cranial Sinuses* / diagnostic imaging
  • Dominance, Cerebral / physiology
  • Embolization, Therapeutic / methods*
  • Femoral Vein
  • Follow-Up Studies
  • Humans
  • Ischemic Attack, Transient / diagnostic imaging
  • Ischemic Attack, Transient / therapy
  • Jugular Veins
  • Male
  • Middle Aged
  • Postoperative Complications / diagnostic imaging