We report a case of dural arteriovenous fistula (DAVF) of the isolated superior sagittal sinus (SSS) that was successfully treated with transcranial transvenous embolization. The transcranial approach has only been reported in small case series, and its technical details have yet to be discussed.
A 53-year-old man who underwent five craniotomies for an occipitoparietal hemangiopericytoma presented with dizziness and mild cognitive dysfunction 2 months after the last craniotomy. The patient's MRI showed venous congestion of the deep medullary veins of the bilateral cerebral hemispheres. Cerebral angiography revealed a DAVF of the SSS with cortical reflux. As the posterior part of the SSS had been removed in the previous surgery, the transcranial approach was applied for embolization of the fistula. An oval craniectomy above the SSS was prepared anteriorly to the DAVF in the operating room. The SSS was punctured by an 18-gauge cannula under fluoroscopic guidance in the angiography room on the following day. Through the outer sheath of this cannula, the fistula was embolized with platinum coils. The venous congestion showed significant improvement on postoperative imaging, along with improvements in cognitive impairment and dizziness.
Thus, direct sinus puncture can be a useful option for transvenous embolization of DAVF when the typical transjugular approach is difficult.