Sigmoid Sinus Dural Arteriovenous Fistula Research Articles

Transsinusal embolization of transverse sigmoid sinus dural arteriovenous fistula in a hybrid operating room: A technical note

BackgroundUsing the transverse sinus as a conduit to treat a transverse sigmoid sinus dural arteriovenous fistula is uncommon. This report describes a minimally invasive direct puncture technique for the transverse sinus to treat a complex dural arteriovenous fistula in a hybrid operating room. CaseThe patient was a 64-year-old man with intractable status epilepticus. Digital subtraction angiography demonstrated a right transverse sigmoid sinus dural arteriovenous fistula (Borden type II, Cognard type IIa+b). We performed a transcranial direct puncture because the femoral vein approach was not feasible due to bilateral thrombosed sinuses. Under general anesthesia and park-bench patient positioning, the transverse sinus was exposed and catheterized, and the affected sinus was embolized using microcoils. The fistula was completely obliterated, resolving the status epilepticus. ConclusionsDirect puncture of the transverse sinus can be effective for treating a transverse sigmoid sinus dural arteriovenous fistula. In a hybrid operating room, combined treatments can be performed comfortably and safely in a single session of general anesthesia. This treatment option is a viable alternative when other methods are unsuccessful.

Balloon-backstop technique: Preserving physiologic venous drainage during transvenous coil embolization of sigmoid sinus dural arteriovenous fistulas.

Dural arteriovenous fistulas can lead to catastrophic intracranial hemorrhage if left untreated. Transvenous embolization can cure arteriovenous fistulas, but preserving normal venous structures can be challenging. Inadvertent embolization of a functioning vein can result in catastrophic venous infarction or hemorrhage. Here, we report a case using balloon-assistance to facilitate preservation of the superior petrosal sinus during transvenous embolization of a sigmoid sinus dural arteriovenous fistula.

Sigmoid Sinus Dural Arteriovenous Fistula Presenting with Myelopathy―Report on Two Cases―

Sigmoid Sinus Dural Arteriovenous Fistula Presenting with Myelopathy―Report on Two Cases―

Endovascular management of sigmoid sinus dural arteriovenous fistula associated with sinus stenosis in an infant

A 4-month-old female presented with a dural arteriovenous fistula (DAVF), which was successfully managed using endovascular techniques. There are very few case series reporting DAVF in infants younger than 12months and, to our knowledge, only 60 pediatric patients with DAVF have been reported to date. Although most DAVF have a benign course, they can result in life-threatening hemorrhage. Endovascular therapies are usually indicated in the management of these neurosurgical vascular malformations. Endovascular therapy of DAVF in neonatal patients presents some major issues. Gaining arterial access may be problematic in femoral arteries too small for the introduction of a sizeable guiding catheter. The volumes of contrast and infused fluids must be carefully monitored to prevent fluid overload. Radiation exposure should be restricted as far as possible. This report contributes to the limited body of evidence on neonatal DAVF and its endovascular management.

A case of isolated transverse sigmoid sinus dural arteriovenous fistula in which ipsilateral sensory neural hearing loss developed after transvenous embolization—letter to the editor

Dear Sir, We would like to report a rare complication after transvenous embolization (TVE) of an isolated transverse sigmoid sinus (TSS) dural arteriovenous fistula (dAVF). A 72-year-old male complaining of right pulsatile tinnitus was referred to our hospital. A bruit was identified in the post-auricular region on the right side. There were no neurological deficits. Diagnostic angiography demonstrated a dAVF fed by branches of the occipital and posterior auricular artery and ending in an isolated transverse sigmoid sinus (Fig. 1a). The venous phase of the right common carotid angiography demonstrated absence of opacification of the diseased sinuses and of the ipsilateral inferior petrosal sinus (IPS) and jugular Bulb (JB) (Fig. 1b). TVE was performed under general anesthesia. A microcatheter was navigated to the diseased sinus via contralateral approach. This segment of sinuses was packed with detachable microcoils (GDC®/Targets Therapeutics, Fremont, CA, USA). Final control angiography showed complete obliteration of the shunt (Fig. 2). The pulsatile tinnitus disappeared immediately after the procedure. On postoperative day 1, the patient complained of dizziness, but MR with diffusion weighted images showed no abnormal findings. The dizziness improved within 10 days. After 10 days of hospitalization, a sudden hearing loss occurred in the right ear. Puretone audiography revealed a sensory neural hearing loss (SNHL) of 40 dB. A tentative diagnosis of sudden SNHL (SSNHL) was made by the ENT specialists. Intravenous drip infusion of corticosteroids and low molecular dextrin was initiated. Two weeks later, hearing loss had improved with 15 dB. To the best of our knowledge, no previous reports have described SNHL after TVE of a dAVF. When considering the etiology of the hearing loss in our case, two aspects must be discussed. First it should be made out whether this SNHL occurred incidentally or as a consequence of the procedure. Secondly, if the embolization caused the SNHL, the potential pathogenesis and clinical significance of the SNHL should be investigated. If the hearing loss was coincidental, the diagnosis of SSNHL would be the most likely diagnosis. Nevertheless, in the literature, the incidence of SSNHL is reported as low as 5–20/100,000 person-years [1, 2]. Moreover, it is highly unlikely that ipsilateral SSNHL would occur incidentally within 10 days after TVE. Therefore, it seems more likely that this SNHL has arisen as a consequence of the procedure. Although various reports have described SNHL caused by anesthesia [3], radiation [4], and contrast medium administration [5], these potential causes of hearing loss seem not to match for our case. Therefore, we considered that TVE itself must be responsible for this SNHL. Anatomically, the inner ear has two main venous drainage routes: the vein of the vestibular aqueduct (VVAQ) draining into the vertical portion of the sigmoid sinus or superior petrosal sinus (SPS); and the vein of cochlear aqueduct (VCAQ) draining into the JB or the caudal end of the IPS (Fig. 3a) [6]. Watanabe et al. reported the precise venous drainage of the inner ear in guinea pigs [7]. They reported the presence of minor collateral vessels between the VCAQ and the mucoperiosteal veins of the middle ear, which act as collateral channels in the event of venous congestion of the inner ear [7]. S. Yamauchi (*) :A. Nishio Department of Neurosurgery, Hokuto Hospital, 7-5 Inada, Obihiro, Hokkaido 080-0033, Japan e-mail: ymailadd@silver.ocn.ne.jp

High-flow Hemodialysis Arteriovenous Shunt with Concurrent Central Vein Stenosis Masquerading as Sigmoid Sinus Dural Arteriovenous Fistula

High-flow Hemodialysis Arteriovenous Shunt with Concurrent Central Vein Stenosis Masquerading as Sigmoid Sinus Dural Arteriovenous Fistula

Cavernous Redirection of Venous Drainage after Partial Transvenous Coil Occlusion of a Sigmoid Sinus dAVF: Coil Mass Retrieval with Flexible Cysto-Urethroscopy Grasping Forceps

We describe the case of a patient who presented with ocular symptoms (chemosis, proptosis, increased intra-ocular pressure, impaired visual acuity) eight months after the transvenous coil occlusion of an ipsilateral sigmoid sinus dural arteriovenous fistula (dAVF). Digital substraction angiography revealed a partial occlusion of the left sigmoid sinus with coils. Since the connection from the sigmoid sinus to the internal jugular vein was obliterated by coils without interrupting the arteriovenous shunt, the venous drainage was redirected into the inferior petrosal sinus, the cavernous sinus and the superior ophthalmic vein. The transjugular access to the inferior petrosal sinus was obstructed by a large coil mass in the jugular bulb. Several attempts to remove these coils with an Alligator retrieval device and a goose neck snare failed. The coil mass was withdrawn via a direct access to the internal jugular vein using flexible cysto-urethroscopy grasping forceps, an urological device designed for the removal of kidney stones. After establishing anterograde drainage, the now accessible inferior petrosal sinus was occluded with fibered coils and the dAVF was completely obliterated. The ocular symptoms resolved within ten days.

Transvenous embosurgery of a left sigmoid sinus dural arteriovenous fistula via a retrograde approach from the superior ophthalmic vein, cavernous and inferior petrosal sinuses

The efficacy and safety of transvenous embosurgery for sigmoid sinus dural arteriovenous fistula (DAVF) using the internal jugular vein approach is well known. Embosurgery of cavernous sinus DAVF has also...

Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

A 69-year-old woman presented with an extremely rare sigmoid sinus dural arteriovenous fistula (AVF) with venous drainage into a spinal perimedullary vein manifesting only as brainstem dysfunction without myelopathy. Cerebral angiography showed retrograde venous drainage into both the brainstem and spinal cord through the ipsilateral bridging vein from the affected isolated sigmoid sinus. Magnetic resonance (MR) imaging showed a hyperintense lesion in the medulla oblongata and lower pons with increased apparent diffusion coefficient (ADC), and enhancement with contrast material. The dural AVF was successfully treated by transfemoral transvenous embolization from the contralateral side, but the hyperintense area and neurological symptoms persisted after the treatment. The neurological deficits were probably due to venous hypertension associated with accessory retrograde venous drainage into the brainstem. MR imaging enhancement of the lesion may be more closely related to the prognosis of neurological deficits than the ADC value.

Venous Infarction Associated with a Sigmoid Sinus Dural Arteriovenous Fistula

Dural arteriovenous fistulas with restricted antegrade venous flow and reflux into a dural sinus or cortical veins lead to intracranial venous hypertension. This type of venous hypertension in return may cause parenchymal damage by mechanisms similar to those proposed for venous infarction. A 42-year-old man presented with homonymous hemianopsia of the right upper visual field. Computed tomography demonstrated hypointensity in the left occipital lobe. Angiography confirmed dural arteriovenous fistula of the left sigmoid sinus, severe stenosis and occlusion of the left sigmoid sinus and reversal of the flow in the cortical veins. This fistula was treated with Onyx-18. This report emphasizes an unusual coexistence of venous infarction with sigmoid sinus dural arteriovenous fistula causing neurological symptoms.

Role of angiography in the evaluation of patients with pulsatile tinnitus.

Pulsatile tinnitus in the face of normal findings on otoscopy is a common otological diagnostic dilemma and can be due to serious vascular malformations such as transverse or sigmoid sinus dural arteriovenous fistula (transverse or sigmoid sinus [TS] DAVF). Left untreated, TS DAVF may result in significant morbidity and mortality. TS DAVF can be suspected or diagnosed with computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA), with the gold standard being angiography. Our objective was to assess the utility of these various diagnostic modalities in the diagnosis of dural arteriovenous fistula. Retrospective clinical review. Between 1986 and 1996, 54 patients were evaluated and treated for TS DAVF. Between 1996 and 1999, an additional 33 patients underwent MRI combined with MRA for the evaluation of pulsatile tinnitus. A retrospective review of the medical records for both groups, with special attention to clinical presentation, diagnostic evaluation, therapy, and outcome, was performed. All patients had pulsatile tinnitus with normal findings on otoscopy. CT scan was relatively insensitive in the detection of TS DAVF. MRI and MR/MRA were significantly more sensitive than CT. In the evaluation of patients with subjective pulsatile tinnitus, MRI/MRA defined anatomical abnormalities that may contribute to pulsatile tinnitus in 63% of patients. In the absence of objective pulsatile tinnitus, MRI/MRA is an appropriate initial diagnostic step. When a patient has an objective bruit, the clinician may choose to proceed directly to angiography to make certain that a TS DAVF is not missed.