J Neurol Surg A Cent Eur Neurosurg 2012; 73(03): 167-170
DOI: 10.1055/s-0032-1313591
Technical Note
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Complete Endovascular Occlusion of a Cranial Dural Fistula using a Venous “To the Point” Approach[*]

E. R. Gizewski
1   University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen, Germany
3   UKGM, Justus-Liebig University, Department of Neuroradiology, Giessen, Germany
,
S. L. Göricke
1   University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen, Germany
,
N. Özkan
2   University Hospital Essen, Department of Neurosurgery, Essen, Germany
,
A. E. Grams
3   UKGM, Justus-Liebig University, Department of Neuroradiology, Giessen, Germany
,
M. E. Ladd
1   University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen, Germany
,
U. Sure
2   University Hospital Essen, Department of Neurosurgery, Essen, Germany
,
M. Forsting
1   University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen, Germany
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Publikationsverlauf

Publikationsdatum:
03. Mai 2012 (online)

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Abstract

Background and Object Cranial dural arteriovenous fistulas are commonly treated using an endovascular method. In comparison to intracerebral arteriovenous malformations, it is important to reach the venous part of these malformations to maintain a complete occlusion. Therefore, often the venous side is totally occluded using coils and∕or glue.

Patient and Methods We describe a patient with an initially Type IIab (Cognard classification) left occipital cranial fistula. The patient suffered from an intense pulsate tinnitus. Therefore, the first embolization was performed using an approach via the dilated left middle meningeal artery using Onyx. The shunt of the fistula was reduced significantly but total occlusion was impossible. Therefore, the venous approach was used. Over a guiding catheter in the sigmoid sinus, the venous side of the fistula could be reached with a microcatheter. This part of the fistula was then completely occluded using coated and bare coils, without occluding the adjacent sinus. Control angiography of all previous feeders showed a complete occlusion of the fistula (used classification: Cognard[2]).

Results The fistula was entirely occluded. The patient's outcome was excellent. The patient did not develop any symptoms and no complication occurred due to the treatment.

Conclusions Direct occlusion of the venous part of an arteriovenous cranial fistula can be an option before an occlusion of the sinus has to be performed. This approach can lead to reduction of risk during the endovascular procedure and risk reduction in long-term follow-up.

* This article was originally published online in Central European Neurosurgery on May 2, 2011 (DOI:10.1055/s-0031-1271731)