Abstract
Four cases with dural arteriovenous fistulas (AVFs) of the posterior fossa were treated by endovascular surgery. The dural AVF of case 1 (type-II in Piton's classification) recanalized soon after the transarterial embolization and the affected sinus was finally resected surgically. Case 2, with a multicomponent dural AVF (type-III) in the transverse-sigmoid sinus and foramen magnum, was treated by 3-staged endovascular surgeries. The first transarterial embolization markedly reduced the blood flow of the transverse-sigmoid sinus. Since the sinus was occluded by each side, it was packed with coils by craniotomy. The dural AVF involving the foramen magnum was obliterated by transvenous embolization through a femoral route. The transverse-sigmoid sinus of case 3 (type-III) was also occluded by each side, and embolized by craniotomy under the local anesthesia. The sigmoid sinus of case 4 (type-I) was obliterated by transvenous embolization under the flow restriction by temporary balloon occlusion of the main feeding artery. It is obvious from our result that the transvenous embolization is a more radical endovascular treatment for the dual AVF of the posterior fossa. The transarterial embolization is considered a potent procedure as a supplementary method of the transvenous embolization.
