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.
Key-words:
Cannulation - embolization - fistula - Onyx
®
