Dural AVM of the transverse and sigmoid sinus occupies 63% of the all intracranial dural AVMs. However, radical removal of this type of AVM had been hazardous due to severe intraoperative hemorrhage. We performed artificial embolization of the AVM nidus from the main feeder and ligation of the ECA just prior to radical surgery for the dural AVM. Total bood loss during the operation was estimated to be less than 500 ml.
A 43-year-old female patient was admitted to our clinic complaining of left pulsatory tinnitus and intractable headache. Marked bruit and pulsation were noticed in her left retroauricular area. The selective ECA, ICA and VA angiography revealed an AVM nidus around the junction between the left transverse and sigmoid sinus. The nidus was fed by the left occipital artery and many branches of the medial meningeal artery and accessory meningeal artery, and drained into the left transverse sinus, of which the distal end was completely occluded by the AVM nidus. Gelfoam and Ivalon powder were used for artificial embolization through the occipital artery, and the radix of the ECA was ligated just prior to the radical surgery. The total removal of the dural AVM including the nidus and draining sinus could be achieved with minimum bleeding during the operation. All symptoms subsided, and the AVM disappeared angiographically after the operation, with only a small temporary skin erosion of the scalp flap remaining.
