Current status of endovascular treatment for dural arteriovenous fistula of the transverse-sigmoid sinus: A literature review

Abstract

Most intracranial dural arteriovenous fistulae (DAVFs) involve the transverse-sigmoid sinus (TSS), and various types of endovascular treatment (EVT) have been involved in managing TSS DAVFs. A current, comprehensive review of the EVT of TSS DAVFs is lacking. This study used the PubMed database to perform a literature review on TSS DAVFs to increase the current understanding of this condition. For high-grade TSS DAVFs such as Borden type 3, the goal of EVT is curative treatment. However, for low-grade TSS DAVFs such as Borden type 1 and some Borden type 2 TSS DAVFs, symptom relief or elimination of cortical reflux may be sufficient. Currently, EVT has become the first-line treatment for TSS DAVFs, including transarterial embolization (TAE), transvenous embolization (TVE) or both. TAE alone and TSS balloon-assisted TAE are also commonly used. However, TVE for TSS DAVFs is recognized as the most effective treatment, including coil direct packing TSS, Onyx® (ethylene vinyl alcohol copolymer) TVE, and balloon-assisted Onyx® TVE, which are commonly applied. In addition, TSS reconstructive treatment can be an effective procedure to treat TSS DAVFs. EVT is accompanied with complications, including technique- and treatment-related complications. Although complications may occur, TSS DAVFs have an acceptable prognosis after EVT.

Intracranial Dural Arteriovenous Fistula Presenting With Bulbar and Myelopathic Features: Case Report and Literature Review

“…The relative rarity of DAVFs means large studies in the literature regarding their management are yet to be performed [12]. Minimally invasive options to treat DAVFs include transarterial embolisation (TAE) or transvenous embolisation (TVE) or a combination of both [13]. The goal of TAE is to use Onyx® to penetrate the fistula and completely embolise the fistula [13].…”

“…Minimally invasive options to treat DAVFs include transarterial embolisation (TAE) or transvenous embolisation (TVE) or a combination of both [13]. The goal of TAE is to use Onyx® to penetrate the fistula and completely embolise the fistula [13]. If this cannot be achieved due to the DAVF possessing multiple fistula points, balloon-assisted TAE alongside Onyx® embolisation may be used [13].…”

“…The goal of TAE is to use Onyx® to penetrate the fistula and completely embolise the fistula [13]. If this cannot be achieved due to the DAVF possessing multiple fistula points, balloon-assisted TAE alongside Onyx® embolisation may be used [13]. TVE can be performed either via coil packing of the fistula, Onyx® embolisation or via balloon-assisted Onyx® TVE [13].…”

“…If this cannot be achieved due to the DAVF possessing multiple fistula points, balloon-assisted TAE alongside Onyx® embolisation may be used [13]. TVE can be performed either via coil packing of the fistula, Onyx® embolisation or via balloon-assisted Onyx® TVE [13]. Micro-surgery was used in this case, after the check DSA confirmed non-resolution of the DAVF.…”

Clinical importance of the occipital artery in vascular lesions: A review of the literature

“…With the aid of the new double-lumen balloon, the OA may now represent a valuable alternative to the MMA for the embolisation of transverse-sigmoid sinuses DAVFs with the liquid embolic material Onyx (Medtronic-Covidien, Irvine, CA). 45,55 During the OA approach, the embolisation from the proximal OA should be carefully avoided, as it can be dangerous because of the potential presence of either seen or unseen occipito-vertebral anastomoses that can open. Thus, the distal catheter position is vital to prevent the possibility of basilar stroke.…”