A Case of Transverse-sigmoid Sinus Dural Arteriovenous Fistula Treated by Transarterial and Transvenous Embolization via the Balloon Microcatheter with Overinflated Balloon Protection of the Torcula

Abstract

Objective:The objectives of treating dural arteriovenous fistula (dAVF) are to achieve complete occlusion of the arteriovenous (AV) shunt and restoration of anterograde venous flow. We report a patient with complex dAVF who was managed by double overinflated balloon protection of the torcula and percutaneous transluminal angioplasty (PTA) for the occluded venous sinus. Case Presentation:A 62-year-old woman was admitted with gradually worsening nausea and vomiting, as well as progressive memory disturbance and left hemiparesis. Head MRI/MRA demonstrated a dAVF involving the region from the right sigmoid sinus (SS) to transverse sinus (TS) along with occlusion of the left TS and right proximal SS. There was associated dilatation of the right TS, torcula, and superior sagittal sinus (SSS). The intracranial venous circulation was impaired, with venous reflux draining into the deep cerebral veins as well as the cortical veins. Transarterial embolization (TAE) and transvenous embolization (TVE) were performed with double overinflated balloon protection of the torcula, and shunt flow was completely abolished. The occluded sinus was recanalized by PTA. Her symptoms gradually improved after treatment. Conclusion:In this patient, double overinflated balloon protection was effective for maintaining the torcula.

A Novel Approach for Transvenous Embolization of Dural Arteriovenous Fistula Using a Balloon and a Coil as Walls: Case Presentation

“…If one balloon is unable to create a large enough wall, placing the two in parallel is possible. The strategy was different from ours, and the balloon was not used to assist the approach; however, Yabuzaki et al reported a case of DAVF treated using two balloons in the sinus [11]. The duration of complete occlusion of the sinus, including SSS, is unknown, but even with incomplete occlusion as in our case, the balloon can function well as a wall.…”

Gradual dilatation of an occluded transverse sinus associated with dural arteriovenous fistula after balloon angioplasty with sinus packing: A case report

“…Table 1 shows a summary of these cases. [4][5][6][7][8] This is the first case reporting in detail about dilatation of the occluded sinus associated with DAVF over time after balloon angioplasty.…”

Endovascular Treatment for Dural Arteriovenous Fistulae Using a Sinus Protection Balloon to Maintain the Patency of the Dural Sinus

“…However, the sinus diameter exceeds 10 mm in some cases, in which parallel arrangement of several balloons may be adopted. 4) Using balloons available in Japan, it is difficult to obliterate the normal sinus using those for standard aneurysmal neck remodeling due to their inflated diameters. Furthermore, PTA balloons for the carotid artery or peripheral blood vessels were also initially used after the introduction of this procedure (2008).…”

“…In areas with a vascular diameter of >14 mm, such as the sinus confluence, it is possible to obliterate the orifice of a shunt to the sinus by inserting several balloons in parallel. 4) The usage of the Shoryu is summarized below.…”

“…At an infusion volume of 2 mL, the balloon diameter and length were 10–12 and 20–30 mm, respectively, although the size was not uniform, suggesting that most sinuses can be safely and accurately obliterated. 3 , 4) As an advantage of this balloon, it is supercompliant, facilitating accurate obliteration of irregular sinuses. In this study, we introduce radical embolization of dAVFe under sinus preservation using this balloon in patients with a patent sinus.…”