J Korean Neurosurg Soc.  2012 Nov;52(5):480-483. 10.3340/jkns.2012.52.5.480.

Dural Arteriovenous Fistula Involving an Isolated Sinus Treated Using Transarterial Onyx Embolization

• Ihn YK
• Kim MJ
• Shin YS
• Kim BS

• KMID: 2018256
• DOI: http://doi.org/10.3340/jkns.2012.52.5.480

Abstract

The authors present a case of isolated dural arteriovenous fistula (DAVF) in the transverse sinus, which developed six years after microvascular decompression caused by hemifacial spasm via suboccipital craniectomy. The lesion was successfully treated by transarterial embolization using Onyx. We reviewed the related radiologic and therapeutic features of DAVF involving an isolated sinus and described the feasibility of the use of Onyx.

Keyword

Dural arteriovenous fistula; Isolated sinus; Onyx; Embolization

MeSH Terms

Central Nervous System Vascular Malformations
Hemifacial Spasm
Microvascular Decompression Surgery

Figure

• 

  Fig. 1 69-year-old female patient with an isolated transverse sinus dural arteriovenous fistula. A : An axial computed tomography source image shows curvilinear subcortical calcification and mild adjacent sulcus effacement in the right temporal lobe. B : Contrast-enhanced magnetic resonance angiography shows a dural arteriovenous fistula in the region of the isolated transverse sinus with cortical venous reflux.

• 

  Fig. 2 A (anteroposterior view) and B (lateral view) : Right external carotid artery angiogram showing an isolated transverse sinus dural arteriovenous fistula (DAVF) with a supply from both the right middle meningeal artery and the transosseous occipital artery. C : Lateral road-map image shows successful catheterization of isolated sinus was achieved via the right middle meningeal artery. D : Post embolization angiography shows total DAVF circulatory exclusion. E : Unsubtracted image of the cranium in lateral projection shows the cast of ethylene-vinyl alcohol copolymer.

Reference

1. Brown RD Jr, Wiebers DO, Nichols DA. Intracranial dural arteriovenous fistulae : angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg. 1994; 81:531–538. PMID: 7931586.

2. Cognard C, Januel AC, Silva NA Jr, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage : new management using Onyx. AJNR Am J Neuroradiol. 2008; 29:235–241. PMID: 17989374.

3. Endo S, Kuwayama N, Takaku A, Nishijima M. Direct packing of the isolated sinus in patients with dural arteriovenous fistulas of the transverse-sigmoid sinus. J Neurosurg. 1998; 88:449–456. PMID: 9488298.

4. Hu YC, Newman CB, Dashti SR, Albuquerque FC, McDougall CG. Cranial dural arteriovenous fistula : transarterial Onyx embolization experience and technical nuances. J Neurointerv Surg. 2011; 3:5–13. PMID: 21990779.

5. Ishii R, Ueki K, Ito J. Traumatic fistula between a lacerated middle meningeal artery and a diploic vein; case report. J Neurosurg. 1976; 44:241–244. PMID: 1245862.

6. Kiyosue H, Hori Y, Okahara M, Tanoue S, Sagara Y, Matsumoto S, et al. Treatment of intracranial dural arteriovenous fistulas : current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. Radiographics. 2004; 24:1637–1653. PMID: 15537974.

7. Lucas Cde P, Mounayer C, Spelle L, Piotin M, Rezende MT, Moret J. Endoarterial management of dural arteriovenous malformations with isolated sinus using Onyx-18 : technical case report. Neurosurgery. 2007; 61:E293–E294. discussion E294. PMID: 18091221.

8. Lucas CP, Zabramski JM, Spetzler RF, Jacobowitz R. Treatment for intracranial dural arteriovenous malformations : a meta-analysis from the English language literature. Neurosurgery. 1997; 40:1119–1130. discussion 1130-1132. PMID: 9179884.

9. Metoki T, Mugikura S, Higano S, Ezura M, Matsumoto Y, Hirayama K, et al. Subcortical calcification on CT in dural arteriovenous fistula with cortical venous reflux. AJNR Am J Neuroradiol. 2006; 27:1076–1078. PMID: 16687546.

10. Mullan S. Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae. J Neurosurg. 1994; 80:606–616. PMID: 8151338.

11. Nabors MW, Azzam CJ, Albanna FJ, Gulya AJ, Davis DO, Kobrine AI. Delayed postoperative dural arteriovenous malformations. Report of two cases. J Neurosurg. 1987; 66:768–772. PMID: 3572502.

12. Nogueira RG, Dabus G, Rabinov JD, Eskey CJ, Ogilvy CS, Hirsch JA, et al. Preliminary experience with onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2008; 29:91–97. PMID: 17974618.

13. Sasaki T, Hoya K, Kinone K, Kirino T. Postsurgical development of dural arteriovenous malformations after transpetrosal and transtentorial operations: case report. Neurosurgery. 1995; 37:820–824. discussion 824-825. PMID: 8559314.

14. Stiefel MF, Albuquerque FC, Park MS, Dashti SR, McDougall CG. Endovascular treatment of intracranial dural arteriovenous fistulae using Onyx : a case series. Neurosurgery. 2009; 65:132–139. discussion 139-140. PMID: 19934987.

15. van Dijk JM, terBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke. 2002; 33:1233–1236. PMID: 11988596.

16. Watanabe A, Takahara Y, Ibuchi Y, Mizukami K. Two cases of dural arteriovenous malformation occurring after intracranial surgery. Neuroradiology. 1984; 26:375–380. PMID: 6544379.

17. Yu YL, Chiu EK, Woo E, Chan FL, Lam WK, Huang CY, et al. Dystrophic intracranial calcification : CT evidence of 'cerebral steal' from arteriovenous malformation. Neuroradiology. 1987; 29:519–522. PMID: 3431695.