Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

Neuroradiology. 2009 Jul;51(7):477-83. doi: 10.1007/s00234-009-0524-9. Epub 2009 Apr 8.


Introduction: This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse-sigmoid sinus dural arteriovenous fistulas (TS_dAVF).

Methods: A total of 150 consecutive patients and 348 procedures were evaluated.

Results: Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS_dAVFs. More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial (n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%).

Conclusion: Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Central Nervous System Vascular Malformations / complications
  • Central Nervous System Vascular Malformations / surgery*
  • Cranial Sinuses / surgery*
  • Embolization, Therapeutic / adverse effects
  • Embolization, Therapeutic / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Safety
  • Sinus Thrombosis, Intracranial / surgery
  • Transverse Sinuses / surgery*
  • Treatment Outcome
  • Young Adult