A Case of Transverse-sigmoid Sinus Dural Arteriovenous Fistula Treated by Transarterial and Transvenous Embolization via the Balloon Microcatheter with Overinflated Balloon Protection of the Torcula

Abstract

Objective: The objectives of treating dural arteriovenous fistula (dAVF) are to achieve complete occlusion of the arteriovenous (AV) shunt and restoration of anterograde venous flow. We report a patient with complex dAVF who was managed by double overinflated balloon protection of the torcula and percutaneous transluminal angioplasty (PTA) for the occluded venous sinus. Case Presentation: A 62-year-old woman was admitted with gradually worsening nausea and vomiting, as well as progressive memory disturbance and left hemiparesis. Head MRI/MRA demonstrated a dAVF involving the region from the right sigmoid sinus (SS) to transverse sinus (TS) along with occlusion of the left TS and right proximal SS. There was associated dilatation of the right TS, torcula, and superior sagittal sinus (SSS). The intracranial venous circulation was impaired, with venous reflux draining into the deep cerebral veins as well as the cortical veins. Transarterial embolization (TAE) and transvenous embolization (TVE) were performed with double overinflated balloon protection of the torcula, and shunt flow was completely abolished. The occluded sinus was recanalized by PTA. Her symptoms gradually improved after treatment. Conclusion: In this patient, double overinflated balloon protection was effective for maintaining the torcula.