Percutaneous transvenous embolization of transverse / sigmoid sinus dural arteriovenous fistula through the mastoid emissary vein: case report

Abstract

Objective: Percutaneous transvenous embolization (TVE) of a transverse/sigmoid sinus dural arteriovenous fistula (TS/SS dAVF) through the mastoid emissary vein (MEV) is reported.
Case presentation: A 46-year-old man was admitted to our hospital for cerebral venous infarction. Angiography revealed left TS/SS dAVF with isolated sinus and retrograde cortical venous reflux. Transarterial embolization resulted in successful reduction of the shunt flow and improvement of the clinical symptoms. Transvenous approach through the occluded dural sinus into the affected sinus failed. Direct puncture of the dilated occipital vein was then performed, and TVE using coils was performed successfully through the MEV. This procedure resulted in complete disappearance of the dAVF.
Conclusion: This technique is a simple and good alternative treatment in patients for whom conventional approach to the isolated sinus is difficult to adopt, if there is the drainage of the dilated mastoid emissary vein.