Abstract
We report a transverse-sigmoid dural arteriovenous fistula (DAVF) successfully treated by trans-arterial sinus packing. A 63-year-old man complained of visual field disturbance and suffered from convulsion. Angiography showed isolated sinus DAVF fed by the middle meningeal and occipital arteries that drained into the straight sinus and Galenic vein. We attempted transvenous approaches to the affected sinus, but failed to access the site. Two days later, the patient complained of dysarthria, and CT showed diffuse edema in the cerebellum. The emergent angiograms showed increased shunt flow and venous retention. We introduced a microcatheter into the middle meningeal artery to reduce shunt flow. At the procedure, we could advance the guide wire and catheter into the affected sinus, and successfully embolized the isolated affected sinus. The patient felt symptom relief the day after the procedure. We propose that the expansion of the shunt channel due to the increased shunt flow might have induced the successful catheter advancement into the affected sinus.
