Trans-cranial embolisation of a complex transverse sigmoid sinus dural arteriovenous fistula by direct puncture of the superior sagittal sinus

Lammy, S. , Bhattacharya, J., Dervin, J. and St. George, E. J. (2018) Trans-cranial embolisation of a complex transverse sigmoid sinus dural arteriovenous fistula by direct puncture of the superior sagittal sinus. Asian Journal of Neurosurgery, 13(3), pp. 946-948. (doi: 10.4103/ajns.AJNS_330_16) (PMID:30283590) (PMCID:PMC6159061)

Abstract

This technical note describes a direct puncture of the superior sagittal sinus (SSS) to treat a complex dural arteriovenous fistula (dAVF). A 40-year-old female was admitted having a history of increasing confusion. Computer tomography revealed enlargement of the right superior ophthalmic vein and magnetic resonance imaging demonstrated extensive bilateral hemispheric venous engorgement. Digital subtraction angiography (DSA) demonstrated a high flow dAVF involving the right transverse sinus. There was extensive cortical venous rerouting with venous sinus occlusion at the right transverse and sigmoid junction. Under general anesthesia, the sinus was exposed and catheterized. The angiography catheter was fed over the guide wire into the sinus. The remaining right sigmoid and transverse sinus were obliterated using a combination of microcoils and Onyx®. She made a good postoperative recovery, and a repeat DSA at 30 days postoperatively showed evidence of the meningohypophyseal trunk but complete occlusion of the fistula. A check DSA 2 years later confirmed no evidence of a residual fistula. Our case demonstrates the potential use of the SSS as a novel conduit to treat distant targets.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lammy, Dr Simon
• Authors: Lammy, S., Bhattacharya, J., Dervin, J., and St. George, E. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Asian Journal of Neurosurgery
• Publisher: Wolters Kluwer
• ISSN: 1793-5482
• ISSN (Online): 2248-9614
• Published Online: 31 July 2018
• Copyright Holders: Copyright © 2018 Asian Journal of Neurosurgery
• First Published: First published in Asian Journal of Neurosurgery 13(3): 946-948
• Publisher Policy: Reproduced under a Creative Commons License