Direct packing of the isolated sinus in patients with dural arteriovenous fistulas of the transverse—sigmoid sinus

Endo, Shunro; Kuwayama, Naoya; Takaku, Akira; Nishijima, Michiharu

doi:10.3171/jns.1998.88.3.0449

Cited by 114 publications

(40 citation statements)

References 28 publications

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“…This can be achieved by either surgical or endovascular procedures. [13][14][15][16][17][18] Total resection of the DAVF itself with or without sacrifice of the dural sinus may not be necessary. Disconnection of the CVR alone may suffice because lesions without CVR have been shown to follow a benign course.…”

Section: Discussionmentioning

confidence: 99%

Clinical Course of Cranial Dural Arteriovenous Fistulas With Long-Term Persistent Cortical Venous Reflux

Dijk

terBrugge

Willinsky

et al. 2002

Stroke

573

312

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Background and Purpose — The natural history of aggressive (Borden 2 and 3) cranial dural arteriovenous fistulas (DAVFs) is not well described. Reported annual mortality and hemorrhage rates vary widely and range up to 20% per year. A consecutive single-center cohort of 236 cases that presented with a cranial DAVF between June 1984 and May 2001 was reviewed for the consequences of long-term persistent cortical venous reflux (CVR). Methods — A group of 118 cranial DAVFs was selected for the presence of CVR. All patients were offered treatment aimed at the disconnection of the CVR. Patients who declined or had partial treatment with persistence of the CVR had long-term clinical and angiographic follow-up to study the disease course of this select group. Results — Treatment was instituted in 101 of the 118 patients (85.6%). Three patients were lost to follow-up. The remaining 14 nontreated patients (11.9%) and the partially treated patients (n=6) were assessed clinically and angiographically over time. The mean follow-up in this select group was 4.3 years (86.9 patient-years). During follow-up, 7 patients suffered an intracranial hemorrhage (35%). The incidence of nonhemorrhagic neurological deficit was 30%. Nine patients (45%) died: 6 patients expired after a hemorrhage, and 3 patients died of progressive neurological deterioration. Two patients demonstrated a spontaneous closure of the DAVF (10%). Conclusions — Persistence of the CVR in cranial DAVFs yields an annual mortality rate of 10.4%. Excluding events at presentation, in this series the annual risk for hemorrhage or nonhemorrhagic neurological deficit during follow-up was 8.1% and 6.9%, respectively, resulting in an annual event rate of 15.0%.

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Section: Discussionmentioning

confidence: 99%

Clinical Course of Cranial Dural Arteriovenous Fistulas With Long-Term Persistent Cortical Venous Reflux

Dijk

terBrugge

Willinsky

et al. 2002

Stroke

573

312

View full text Add to dashboard Cite

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“…5,12) Direct sinus packing with microcoils through a small craniotomy has been proposed. 3) In the present case, the proximal segment of the sigmoid sinus was occluded, and the affected sinus was small. Direct puncture was considered to be very difficult because of such anatomical characteristics.…”

Section: Discussionmentioning

confidence: 87%

Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

Sugiura¹,

Nozaki²,

Sato³

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 69-year-old woman presented with an extremely rare sigmoid sinus dural arteriovenous fistula (AVF) with venous drainage into a spinal perimedullary vein manifesting only as brainstem dysfunction without myelopathy. Cerebral angiography showed retrograde venous drainage into both the brainstem and spinal cord through the ipsilateral bridging vein from the affected isolated sigmoid sinus. Magnetic resonance (MR) imaging showed a hyperintense lesion in the medulla oblongata and lower pons with increased apparent diffusion coefficient (ADC), and enhancement with contrast material. The dural AVF was successfully treated by transfemoral transvenous embolization from the contralateral side, but the hyperintense area and neurological symptoms persisted after the treatment. The neurological deficits were probably due to venous hypertension associated with accessory retrograde venous drainage into the brainstem. MR imaging enhancement of the lesion may be more closely related to the prognosis of neurological deficits than the ADC value.

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“…So the T-S sinus may have been already occluded before treatment so it is difficult to treat 6 of the affected sinus. Nemoto reported opening an occluded sinus with a guidewire, so called kuru-kuru method 11 .…”

Section: Discussionmentioning

confidence: 99%

“…contralateral approach 1 or direct puncture 6 , etc. We basically treat these dAVFs by transfemoral transvenous embolization via the ipsilateral side if there is a thrombosed and isolated sinus or not.…”

mentioning

confidence: 99%

Transfemoral Transvenous Embolization of Dural Arteriovenous Fistulas Involving the Isolated Transverse-Sigmoid Sinus

et al. 2007

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Dural arteriovenous fistulas involving the transverse-sigmoid sinus (T-S dAVFs) are sometimes isolated because this affected sinus is often thrombosed. It is difficult to perform to microcatheter cannulation to the isolated sinus through the thrombosed portion. We are now treating these T-S dAVFs by transfemoral transvenous embolization via the ipsilateral side even if the affected sinus is thrombosed and isolated or not. We use a triaxial system (6 Fr. guiding catheter / 4 Fr. diagnostic catheter / microcatheter) to emphasize the pushability and handling of the microcatheter. And we insert 4 Fr. Catheter into the affected sinus. So we can perform microcatheter cannulation into the isolated and affected sinus for treatment by coil embolization with various detachable coils.

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Direct packing of the isolated sinus in patients with dural arteriovenous fistulas of the transverse—sigmoid sinus

Abstract: Direct sinus packing was found to be highly effective for the treatment of dural AVFs that empty into the isolated sinus. Measurement of changes in sinus pressure and sinus blood gas levels was useful for monitoring the progress of direct sinus packing.

Cited by 114 publications

References 28 publications

Clinical Course of Cranial Dural Arteriovenous Fistulas With Long-Term Persistent Cortical Venous Reflux

Clinical Course of Cranial Dural Arteriovenous Fistulas With Long-Term Persistent Cortical Venous Reflux

Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

Transfemoral Transvenous Embolization of Dural Arteriovenous Fistulas Involving the Isolated Transverse-Sigmoid Sinus

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