Abstract
Objective: We report a case of recurrent dural arteriovenous fistula (dAVF) at the transverse-sigmoid junction cured using transvenous n-butyl-cyanoacrylate (NBCA) injection in combination with platinum coils.
Case presentation: A 70-year-old man presented with headache and dizziness 32 months after embolization for dAVF, which had been considered obliterated. MRI of the head showed brain edema in the left cerebellar hemisphere and some flow voids on the surface of the left cerebellum. Cerebral angiography demonstrated a recurrent shunt with cortical venous reflux and transvenous embolization was performed. After we deployed coils in the compartmentalized transverse sinus, venography from the microcatheter showed the left occipital and middle meningeal artery filled in a retrograde manner. Septa inside the left transverse sinus made navigation of the microcatheter and deployment of coils in the left transverse sinus near the fistulous point difficult. We injected NBCA from the transverse sinus, beyond the fistulous point, to the most distal part of the feeders. Control angiography revealed elimination of the shunt.
Conclusion: In dAVF cases with an isolated sinus, transvenous injection of the NBCA can eliminate the shunt after occluding the cortical venous outlet. To avoid complications, sufficient anatomical knowledge and a sophisticated technique for NBCA injection are necessary.
