Arteriovenous malformations of the transverse dural sinus

Abstract

Clinical, radioanatomical, and therapeutic aspects of dural arteriovenous malformations in the region of the transverse sinsu are discussed on the basis of seven personal observations and the analysis of 72 reported cases. Common symptoms are headache and troublesome tinnitus aurium. More serious neurological deficiencies may occur as a result of distrubance in cerebral hemodynamics. A complete neuroradiological investigation is essential for adequate treatment. Most frequent arterial feeders are the occipital, tentorial, and middle meningeal arteries. Ligation of the occipital artery is not sufficient in most cases. Operative isolation of the transverse sinus by craniotomy and dural section is considered by far the most successful treatment and should be performed whenever ligations fail or are not indicated.

A school of red herring

“…7,23 One postulated mechanism for elevated ICP is that increased dural sinus pressure from the fistula results in secondary decreased CSF absorption. 17,18 A dural fistula supplied by the external carotid arteries is a common association of chronic venous sinus occlusion. 25 Ahmed et al postulated that reducing pressure by embolizing the fistula leads to reduction in the venous sinus stenosis.…”

Surgical Neuroangiography

“…Especially in infants, these lesions may lead to cardiac decompensation and death (Table 8.7). Analogous effects occur in the adult population, manifest as papilledema and optic atrophy (Kuhner 1976, Sundt 1983. 8.7, Table 8.8) (Albright 1983, Gursoy 1979, Van de Werf 1964.…”

Pulsatile Tinnitus from a Dural Arteriovenous Fistula

“…Less commonly, papilledema and visual deficits, various cranial nerve dysfunctions, and occasionally subarachnoid hemorrhage may result, although these more serious complications are unlikely except in cases in which cortical venous drainage or venous outflow obstruction becomes a feature. [1][2][3][4][5][6] Probably DAVFs are acquired lesions, not true congenital malformations, resulting from a sinus thrombosis that recanalizes.? :" In the patient with pulsatile tinnitus, DAVFs must be distinguished from paraganglioma, an aberrant course of the internal carotid artery, and a dehiscent (high) jugular bulb.…”