Transcranial Exposure of Large Dural Venous Sinuses for Direct Transvenous Embolization of High-Grade Dural Arteriovenous Fistulas

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Introduction: High-grade dural arteriovenous fistulas (DAVFs) with retrograde cortical leptomeningeal drainage are formidable lesions because of their risk for intracranial hemorrhage. Treatment is aimed at occluding venous outflow to achieve obliteration of the fistula. In DAVFs that involve a large dural venous sinus, occluding venous outflow can be accomplished endovascularly with transvenous embolization. In cases of DAVFs with reflux into cortical leptomeningeal veins, there is usually venous restrictive disease downstream that can prohibit endovascular access via the transfemoral or transjugular routes.