Dural Arteriovenous Fistula at Marginal Sinus: Angiographic Findings and Treatment with Transvenous Coil Embolization

Abstract

Purpose: The purpose of this study was to evaluate the angiographic findings of dural arteriovenous fistulas(dAVFs) at the site of a marginal sinus and to assess the efficacy of transvenous embolizations. Materials and Methods: Six patients in whom an angiographically confirmed dural arteriovenous fistula was present at the site of a marginal sinus were involved in this study. Arterial feeders and the venous drainage of dAVFs were evaluated, and we describe the location of other combined dAVFs. Transvenous, with or without arterial, embolization was performed in all patients, and the angiographic findings and clinical outcomes were evaluated. Results: Ascending pharyngeal and occipital arteries were the main arterial feeders, and dAVFs were also supplied from the meningohypophyseal trunk, posterior auricular artery, middle meningeal arteries, and the accessory meningeal, internal maxillary, and meningeal branch of the vertebral artery. In five of six cases, the supply originated not only from the ipsilateral arterial system, but also from the contralateral system. Posterior venous drainage occurred via the internal jugular vein and the paravertebral venous plexus, and superiorly, via the and cavernous sinus. Au six patients underwent transvenous coil embolization. Except in one case, in which drainage involved the paravertebral venous plexus, the venous route of embolization was the internal jugular vein. In four of six patients, angiography revealed complete occlusion of the fistula, and the clinical symptoms showed complete resolution. In the other two cases there was minimal residual flow, but the clinical symptoms showed improvement. In both, a further fistula was seen at a site other than the marginal sinus. Conclusion: In all patients, the angiographic findings were evaluated and subsequent endovascular treatment was successful. Transvenous embolization involving dAVFs at the site of a marginal sinus were effective; clinical outcomes depended on successful endovascular treatment and the extent of dAVFs.