A Case of Postoperative Transverse Sinus Dural Arteriovenous Fistula Treated with Selective Sinus Packing: Usefulness of Quadriaxial Catheter System

Abstract

Objective: A case in which an isolated sinus type dural arteriovenous fistula (AVF) that newly occurred in the transverse sinus after tumor resection by craniotomy was occluded by selective transvenous embolization (TVE) is reported.Case Presentation: A 50-year-old woman had undergone resection of meningioma of the middle cranial fossa by craniotomy 50 months before. Tinnitus appeared 17 months after surgery, and exhaustive examination showed a dural AVF that appeared de novo in the transverse sinus occluded on the right sigmoid sinus side. The patient noted a heavy feeling of the head 50 months after surgery, and re-examination showed that the fistula became an isolated sinus type due to occlusion also on the confluence of sinus side with exacerbation of cortical venous reflux. After evaluation of the shunt point, the occluded areas were recanalized via the femoral vein by a quadriaxial catheter system using a 6 Fr guiding sheath, a 6 Fr guiding catheter, a 4.2 Fr catheter, and a microcatheter, and selective coil embolization was performed, resulting in disappearance of the shunt. Conclusion:The occluded areas could be recanalized safely due to preoperative evaluation and the use of a quadriaxial catheter system and consequently, selective coil embolization became possible.Keywords▶ postoperative, transverse sinus dural arteriovenous fistula, selective sinus packing, quadriaxial catheter system

Isolated superior petrosal sinus dural arteriovenous fistula treated with selective sinus packing using a quadriaxial catheter system

“…Recently, it has been increasingly reported that support force and manipulability can be obtained using multiple coaxial systems 13 14. We previously reported that the shunt point could be relatively safely approached by recanalising the occluded access route using a quadriaxial system because extra forces would have been exerted at the veins of the access route to these sites 14. Appropriate multiple coaxial systems are considered to obtain good results like a good rod with different characteristics for each part.…”