Transvenous Shunting Point Embolization of a Superior Sagittal Sinus Dural Arteriovenous Fistula

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Objective: We report a patient in whom coil embolization of a dural arteriovenous fistula with a shunting point at the venous lacuna of the superior sagittal sinus led to radical cure.

Case Presentation: The patient was a 45-year-old female. She had a 4-month history of pulsatile tinnitus. For the purpose of treatment, she was referred to our hospital. Angiography showed blood flow from the bilateral middle meningeal arteries to the superior sagittal sinus (SSS) through the venous lacuna. The tip of a 4 Fr intermediate support catheter was inserted into the venous lacuna, and a microcatheter was retrogradely inserted into the right middle meningeal artery. Coil embolization involving the venous lacuna was performed. The disappearance of a shunt was confirmed.

Conclusion: In a patient with a shunting point at the venous lacuna of the SSS, the insertion of an intermediate support catheter with an S-shaped tip into a venous lacuna facilitated embolization.