Endovascular approach and technique for treatment of transverse-sigmoid dural arteriovenous fistula with cortical reflux: The importance of venous sinus sacrifice

摘要

Background Treatment of dural arteriovenous fistula involving the transverse-sigmoid region with cortical reflux is complex and treatment options may require sacrifice of the fistulous segment of the sinus. Objective To review our results in this subset of patients and describe current endovascular decisionmaking and approaches. Methods We reviewed cases of endovascular sinus sacrifice for dural fistulas at our institution from 2007 to 2012. Demographic, decision-making, technical and outcome data were collected. Results Seven patients were identified who underwent endovascular sinus sacrifice for treatment of dural fistula during this 4-year period. Determination of the fistulous sinus segment was based on the pattern of cortical drainage. Endovascular access to the sinus was achieved by transarterial, transvenous or via open surgery in one case. Complete cure of the target fistula was obtained in all cases. One patient had transient post-procedure headache. There were no hemorrhages, new neurological deficits or signs of increased intracranial pressure. Six of the seven patients had angiographic follow-up at least 6 months after treatment with no recurrence. Conclusions Fistulas of the transverse-sigmoid sinuses with cortical reflux may require sacrifice of the parent sinus for cure. Defining the fistulous segment and occluding this segment deliberately, completely and precisely is essential for cure. Several modalities and approaches can be used to achieve this. For properly selected patients, cure of the lesions can be achieved with this method with low risk of morbidity.