A 76-year-old male presented with pulsatile tinnitus in April 1998. Angiography revealed a dural arteriovenous fistula at the left transverse-sigmoid sinus fed by abnormal branches of the occipital artery. The distal portion of the left sigmoid sinus was occluded, thereby venous reflux consisted in the transverse sinus and the cortical veins. The patient has been known to have hypertrophic cardiomyopathy. We performed transvenous embolization of the involved left sigmoid and a part of the transvers sinus. The pulsatile tinnitus disappeared immediately and did not recur in four months following the treatment.
Our experience supports that the transvenous embolization is a safe, efficacious and useful method for a poor risk case. Preoperative angiography is recommended for predicting the risk of critical complications of the dural arteriovenous fistula.
