Document Detail

Reconstructive treatment using a stent graft for a dural arteriovenous fistula of the transverse sinus in the case of hypoplasia of the contralateral venous sinuses: technical case report.
MedLine Citation:
PMID:  19834391     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Transvenous coil embolization for transverse sinus (TS) and sigmoid sinus dural arteriovenous fistulae (DAVFs) is now recognized as one of the most effective treatment modalities. However, in the case of hypoplasia of the contralateral venous sinuses and internal jugular vein, complete occlusion of the ipsilateral sinus may cause fatal consequences. We describe a case of combined intravenous graft stent placement and transarterial coil embolization for DAVFs that involved the dominant right TS in a patient with hypoplasia of the contralateral venous sinuses. CLINICAL PRESENTATION: A 50-year-old man presented with headache, left hand tremor, and pulsatile right tinnitus. A cerebral angiogram demonstrated a right TS DAVF that was supplied by tentorial branches of both internal carotid arteries, multiple branches of the right external carotid artery, and branches of the left occipital artery. Unfortunately, left TS and sigmoid sinus hypoplasia were observed. INTERVENTION: A right TS balloon occlusion test revealed contrast stagnation of the cortical veins and of the right TS and superior sagittal sinus. In this case, the use of transvenous stent graft placement with or without transarterial embolization is safer and more effective than sacrifice of the right TS. We therefore performed balloon-expandable stent graft deployment at the right TS, and the remnant DAVF flow between the stent graft and venous sinus was treated with transarterial coil embolization. Postprocedural angiograms showed patent right TS outflow with disappearance of retrograde cortical venous drainage as well as complete eradication of the fistulous connections. CONCLUSION: In a DAVF involving the dominant TS or sigmoid sinus in a patient with hypoplasia of the contralateral venous sinuses and an intolerable balloon occlusion test for the ipsilateral venous sinuses, the complete occlusion of the diseased venous sinus may cause hazardous consequences. In this situation, the use of a stent graft with or without transarterial embolization to preserve venous sinus flow can be an effective treatment.
Beom Jin Choi; Tae Hong Lee; Chang Won Kim; Chang Hwa Choi
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  65     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2009-12-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E994-6; discussion E996     Citation Subset:  IM    
Department of Diagnostic Radiology, Pusan National University Hospital, Pusan, Republic of Korea.
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MeSH Terms
Central Nervous System Vascular Malformations / complications,  therapy*
Embolization, Therapeutic / methods
Headache / etiology
Middle Aged
Neurosurgical Procedures / methods*
Tinnitus / etiology
Transverse Sinuses / abnormalities*,  surgery*
Tremor / etiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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