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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.
Neurosurgery. 2009 Nov; 65(5):E994-6; discussion E996.N

Abstract

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.

Authors+Show Affiliations

Department of Diagnostic Radiology, Pusan National University Hospital, Pusan, Republic of Korea.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19834391

Citation

Choi, Beom Jin, et al. "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." Neurosurgery, vol. 65, no. 5, 2009, pp. E994-6; discussion E996.
Choi BJ, Lee TH, Kim CW, et al. 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. Neurosurgery. 2009;65(5):E994-6; discussion E996.
Choi, B. J., Lee, T. H., Kim, C. W., & Choi, C. H. (2009). 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. Neurosurgery, 65(5), E994-6; discussion E996. https://doi.org/10.1227/01.NEU.0000351772.45417.92
Choi BJ, et al. 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. Neurosurgery. 2009;65(5):E994-6; discussion E996. PubMed PMID: 19834391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Choi,Beom Jin, AU - Lee,Tae Hong, AU - Kim,Chang Won, AU - Choi,Chang Hwa, PY - 2009/10/17/entrez PY - 2009/10/17/pubmed PY - 2009/12/24/medline SP - E994-6; discussion E996 JF - Neurosurgery JO - Neurosurgery VL - 65 IS - 5 N2 - 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. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/19834391/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_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/01.NEU.0000351772.45417.92 DB - PRIME DP - Unbound Medicine ER -