Treatment of Superior Sagittal Sinus Dural Arteriovenous Fistula by Transarterial Multiple Balloon-assisted Onyx Embolization: A Case Report

Abstract

We report a case of superior sagittal sinus (SSS) dural arteriovenous fistula (dAVF) treated with transarterial Onyx injection under flow control using two balloon guiding catheters and a dual-lumen balloon microcatheter. Case Presentation: A 54-year-old man previously diagnosed with SSS dAVF with cortical venous reflux at 4 years prior, who did not request treatment as he was asymptomatic. During follow-up, he developed right temporal lobe subcortical hemorrhage and showed an occlusive change in venous drainage. We performed transarterial Onyx injection with assistance using multiple balloons placed in the bilateral external carotid and right middle meningeal arteries. Using this technique, we were able to sufficiently fill the proximal part of the venous drainage with Onyx and achieved complete obliteration. No treatment-related complication was observed, and follow-up angiography performed at 8 months after the treatment showed no recurrence. Conclusion: Multiple balloon-assisted transarterial Onyx embolization is useful for adequate fillings of shunt and the proximal part of the venous drainage.

A Comprehensive Analysis of Dural Arteriovenous Fistula Involving the Superior Sagittal Sinus: A Systematic Review

“…With regard to Onyx TAE, balloon-assisted techniques are anticipated to expand the application range of this liquid, non-adhesive agent. In general, these approaches include balloon devascularization of the collateral arterial branches, 22 , 23 , 40) proximal flow control of the injecting artery, 20 , 37 , 40) and protection of the functioning but compromised sinus. 14 , 35) The details of each technique have been described previously.…”