Transvenous embolization for dural transverse sinus fistulas with occluded sigmoid sinus

Abstract

Dural transverse sinus arteriovenous fistulas with cortical venous drainage were associated with a high hemorrhagic risk. Dural transverse sinus arteriovenous dural fistulas could be treated by embolization (transarterial or transvenous), surgery or a combination of both. Transvenous packing of the diseased sinus was considered to be a less invasive and effective method of treatment. Occluded sigmoid sinus proximally, especially cases with isolated transverse sinus, could make the transvenous approach difficult. Craniotomy for sinus packing or surgical excision remained the treatment of choice when the percutaneous transvenous approach was not feasible. We reviewed the techniques of transvenous embolization described in the literature and illustrated our techniques in two consecutive cases of transvenous embolization of the dural arteriovenous fistulas through the occluded sigmoid sinus. We concluded that transvenous embolization remains a safe and feasible technique other than surgery for patients with transverse sinus dural fistula, achieving a long-term occlusion of the pathology.

Transvenous Embolization of Intracranial Dural Arteriovenous Shunts through Occluded Venous Segments: Experience in 51 Patients

“…While Sugiu et al 36 used a 6F guiding catheter with a 4F catheter and a microcatheter in 2 patients, the setup used by us in those cases necessitating distal catheterization included a 6F shuttle sheath and a 6F flexible guiding catheter (eg, Neuron, Penumbra, Alameda, California; or Fargo Max, Balt, Montmorency, France) (Fig 3). The necessity of having good support was also highlighted by 2 cases reported by Wong et al, 31 who attributed their success to the support given by a 6F guiding catheter placed immediately proximal to the occluded sinus.…”

“…Therefore, different groups have reported combined surgical and endovascular approaches, including surgical superior ophthalmic venous access or burr-hole craniotomy with subsequent endovascular treatment or purely surgical approaches with sinus packing or surgical excision. [23][24][25][26][27][28][29][30][31] However, in addition to these surgical techniques, a few groups have described entering a trapped sinus via the occluded venous segment using a purely endovascular technique. 29,32,33 The aim of this article is to describe, in the largest series of patients so far from 2 different hospitals, the venous reopening technique to treat dural AV shunts via a transvenous approach through an occluded segment, including angiographic and clinical outcome and complication rates.…”

Comparison of behavioral effects of cortexin and cerebrolysin injected into brain ventricles

“…The neuroprotective effect of CL manifests in protection of neurons from the destructive effect of lactate acidosis, prevention of free radical formation, and reduction of LPO products concentration on the ischemia-reperfusion model, improvement of neuron survival and prevention of their death under conditions of hypoxia and ischemia, reduction of the destructive neurotoxic effect of stimulating amino acids (glutamate), suppression of apoptosis by caspase inhibition [12,13].…”

“…Cerebrolysin is regarded as a nootropic peptidergic drug with proven neuron-specific neurotrophic activity, similar to the effects of natural neuron growth factors, but manifesting, in contrast to latter, under conditions of peripheral treatment. Cerebrolysin stimulates the formation of synapses, growth of dendrites, and prevents activation of microglial cells and induction of astrogliosis [6,12,13].…”

Combined Surgical and Endovascular Approach to a Complex Dural Arteriovenous Fistula Involving the Superior Sagittal Sinus and Torcula

“…[1][2][3] Complex dAVFs may require combined open surgical and endovascular techniques to achieve successful obliteration. [4][5][6][7][8] As endovascular techniques evolve, novel methods of addressing complex dAVFs will continue to emerge. [9][10][11][12][13] We describe a combined open surgical and endovascular approach to a complex dAVF involving the superior sagittal sinus (SS) and torcula.…”