Percutaneous transvenous embolisation through the occluded sinus for transverse-sigmoid dural arteriovenous fistulas with sinus occlusion

We report six cases of transverse-sigmoid dural arteriovenous fistulae (TS DAVF) treated with percutaneous transvenous embolisation through the occlud ed sinus. All patients had sinus occlusive lesions: an isolated sinus in fi ve cases and a distal occlusion of the affected sinus in one. Leptomeningea l retrograde venous drainage via the vein of Labbe or the sylvian vein was observed in all patients with an isolated sinus. In five patients a microca theter was easily passed through the occluded sinus. In four of them, a com plete angiographic cure was achieved by packing the sinus with coils. Howev er, in one, sinus packing was ineffective and surgical excision of the affe cted sinus was necessary. The microcatheter could not be passed through the occluded sinus in one case, and direct packing of the isolated sinus was l ater required. In all cases, complete cure was achieved without complicatio ns. This safe, not very invasive and highly effective treatment for TS DAVF with sinus occlusion is thus worth trying when the occluded segment is rel atively short.