Dural arteriovenous fistulas (DAVFs) in the transverse-sigmoid sinus (TSS) usually flow into the sinus, and sometimes retrograde venous drainage is observed. We experienced a rare variant of DAVF located in the wall of the transverse-sigmoid sinus and draining only into the cortical vein.
A 55-year-old man presenting with pulsating headache was diagnosed as a DAVF and referred to our hospital. The patient had no neurologic deficit, but a pulsating bruit was heard in the right mastoid area. There was no history of head trauma or surgery. Magnetic resonance imaging (MRI) showed many flow void spots around the right temporal lobe. Contrast-enhanced magnetic resonance angiography showed the large dilated vein of Labbé in the early arterial phase. Angiography disclosed a DAVF located in the superior wall of the transverse-sigmoid sinus.
This DAVF drained directly into the right vein of Labbé in a retrograde fashion but not into the transverse-sigmoid sinus. Cerebral venous blood flow was not affected by the DAVF and drained into the ipsilateral transverse-sigmoid sinus. The patient was successfully treated with transarterial glue embolization.
