Transvenous balloon-assisted transarterial Onyx embolization of transverse–sigmoid dural arteriovenous malformation

Abstract

Transvenous balloon assistance is a useful and feasible technique in the treatment of dural arteriovenous malformation when sinus preservation is in concern.

Endovascular Treatment of Dural Arteriovenous Fistulas of the Transverse and Sigmoid Sinuses Using Transarterial Balloon-Assisted Embolization Combined with Transvenous Balloon Protection of the Venous Sinus

“…At the same time, the technique allows sinus patency control and provides continuous injection of liquid embolic material, minimizing the risk of leakage into the sinus. 8,[10][11][12] Although no permanent clinical complications occurred in our series, inadvertent propagation of Onyx into the proximal vein of Labbé was noted despite balloon inflation inside the main sinus lumen in 1 patient (No. 6), most probably the result of retrograde leakage of liquid embolic material along a parallel channel.…”

“…An inflation time of 2-5 minutes has been used with temporary deflation of the balloon during cessation of Onyx injection to avoid venous infarction due to prolonged transvenous balloon occlusion, especially in the dominant sinus or in those cases involving normal cortical veins. 11 The limitations of our study include its retrospective nature, the small sample size, and, for some patients, the short follow-up period. However, the results were obtained in consecutive patients with a defined pathology who were treated with a standardized endovascular approach.…”

“…[1][2][3][4][5][6][7][8][9] In addition, transvenous balloon-assisted sinus protection during transarterial embolization has been reported to be another useful adjunct to the endovascular treatment of dAVFs. [10][11][12] Transvenous balloon protection of the recipient sinus has mainly been associated with a reduction in inadvertent occlusion of the lumen of a functioning sinus, preservation of venous patency, facilitation of occlusion of abnormal arteriovenous connections within the sinus wall and separate venous channels, and increased penetration of embolic material by retrograde reflux into other dural feeders of the fistula network. Techniques aiming to preserve the underlying sinus may have lower complication rates than sinus-occluding embolization techniques, in which the recipient venous sinus has to be sacrificed.…”

Endovascular Treatment of Transverse-Sigmoid Sinus Type I Dural Arteriovenous Shunts with Sinus Preservation for Patients with Intolerable Symptoms: Four Case Reports

“…Most authors agree that an etiologic treatment should be considered for patients with type I DAVFs, suffering from intolerable symptoms [6]. In such cases, an etiologic management of the disease rather than symptomatic relief is preferred [7].…”

“…Balloon venous sinus protection for transarterial embolization in DAVFs was first described in 2009 [10], reporting two patients with transverse-sigmoid sinus DAVFs, with one case of complete shunt occlusion. Two more cases were later reported [6], with complete obliteration of the shunts.…”