Transvenous Embolization via the Mastoid Emissary Vein in a Patient with Multiple Hemorrhagic Dural Arteriovenous Fistulas

Abstract

Objective: We report a case of multiple dural arteriovenous fistulas (dAVFs) treated with transvenous embolization (TVE) via the mastoid emissary vein (MEV) using a transfemoral venous approach.

Case Presentation: A 52-year-old male presented with intracranial hemorrhage in the right frontal lobe. Diagnostic angiography showed multiple dAVFs of the right transverse sigmoid sinus and the superior sagittal sinus, both associated with cortical venous reflux. Transfemoral TVE of the dAVF of the right transverse sinus sigmoid sinus was performed via the MEV, followed by secondary TVE of the dAVF of the superior sagittal sinus. Complete obliteration of both lesions was achieved without complication.

Conclusion: The MEV is a useful access route for TVE in a patient with isolated dAVF of the transverse sigmoid sinus.