The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas

Neurosurgery. 1997 Jun;40(6):1133-41; discussion 1141-4. doi: 10.1097/00006123-199706000-00004.


Objective: To evaluate the role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas (DAVFs), including its efficacy and safety.

Methods: We retrospectively studied the charts of 24 patients (21 women and 3 men) treated for an intracranial DAVF since 1990 in whom a transvenous approach was attempted either alone (16 patients) or in combination with arterial embolization (8 patients). There were 12 cavernous sinus, 9 transverse-sigmoid sinus, 2 inferior petrosal sinus, and 1 intradiploic fistulas. Three fistulas were Type I, 12 were Type IIa, and 9 were Type IIa+b, according to the revised Djindjian's classification. Transvenous embolic agents included coils (17 patients), detachable balloons (6 patients), bucrylate (2 patients), and silk sutures (1 patient).

Results: Anatomic cure was proven in 21 patients (87.5%). Clinical cure was obtained in 23 cases (96%), as follows: 15 patients with a single transvenous approach, 6 with a combined arteriovenous approach, and 2 with an arterial approach after failure of venous access. There was one persistent cavernous fistula despite coil packing of the cavernous sinus. Complications were as follows: five transient and one permanent sixth nerve palsies in cavernous DAVFs, two transient labyrinthic dysfunctions in transverse sinus DAVFs, and one subarachnoid hemorrhage without sequelae.

Conclusion: Transvenous embolization is a useful and safe approach in the management of intracranial DAVFs.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Arteriovenous Fistula / diagnostic imaging
  • Arteriovenous Fistula / therapy*
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / therapy
  • Cerebral Angiography
  • Cerebrovascular Disorders / diagnostic imaging
  • Cerebrovascular Disorders / therapy*
  • Cranial Sinuses / diagnostic imaging
  • Cranial Sinuses / injuries*
  • Dura Mater / blood supply*
  • Embolization, Therapeutic / instrumentation*
  • Female
  • Femoral Vein
  • Humans
  • Male
  • Middle Aged
  • Treatment Outcome