DIRECT PACKING OF THE ISOLATED SINUS IN PATIENTS WITH DURAL ARTERIOVENOUS-FISTULAS OF THE TRANSVERSE-SIGMOID SINUS

Object. The goal of this study was to evaluate the efficacy of direct packing of the isolated sinus (occluded both distally and proximally) in patients with dural arteriovenous fistulas (AVFs) of the transverse -sigmoid sinus. Methods. Eight patients were included in this study. T here were seven men and one woman, ranging in age from 47 to 75 years (mean 60.4 years). Five patients presented with intracranial hemorrhag e or venous infarction, one with convulsions, and two with pulsatile t innitus. Prominent retrograde cortical venous drainage due to sinus is olation was angiographically demonstrated in all patients. All patient s were treated by a small craniotomy and direct sinus packing with mic rocoils; the procedure was performed with the aid of digital subtracti on angiography. Five patients were pretreated with transarterial embol ization to reduce arterial inflow before the procedure, and intrasinus pressure and sinus blood gases were monitored throughout the operatio n. Postsugery, the dural AVF was completely obliterated in all patient s. The sinus pressure was 29 to 58% of systemic blood pressure, and si nus blood gas levels were purely arterial before packing. There was no morbidity related to direct sinus packing; however, one patient died as a result of acute myocardial infarction. Over a follow-up period ra nging from 1 to 5 years, a faint asymptomatic dural AVF recurred in on e patient on the cortex adjacent to the occluded sinus but regressed s pontaneously within 1 year. Conclusions. Direct sinus packing was foun d to be highly effective for the treatment of dural AVFs that empty in to the isolated sinus. Measurement of changes in sinus pressure and si nus blood gas levels was useful for monitoring the progress of direct sinus packing.