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Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report

Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography reveale...

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Autores principales: Withers, James, Regenhardt, Robert W., Dmytriw, Adam A., Vranic, Justin E., Marciano, Rudolph, Stapleton, Christopher J., Patel, Aman B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10295841/
https://www.ncbi.nlm.nih.gov/pubmed/37371351
http://dx.doi.org/10.3390/brainsci13060871
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author Withers, James
Regenhardt, Robert W.
Dmytriw, Adam A.
Vranic, Justin E.
Marciano, Rudolph
Stapleton, Christopher J.
Patel, Aman B.
author_facet Withers, James
Regenhardt, Robert W.
Dmytriw, Adam A.
Vranic, Justin E.
Marciano, Rudolph
Stapleton, Christopher J.
Patel, Aman B.
author_sort Withers, James
collection PubMed
description Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography revealed a Borden II/Cognard IIa+b DAVF. He underwent stage 1 transarterial embolization of the occipital artery which reduced shunting by 30%. Several attempts were made to access the fistula during stage 2 transvenous embolization, but it was not possible to access the left transverse sinus fistula site since there was no communication across the torcula from the right transverse sinus and the left inferior sigmoid–jugular bulb was occluded. Therefore, a single burr hole was drilled and direct access to the DAVF was achieved with a micropuncture needle under neuronavigational guidance. The left transverse–sigmoid sinus junction was then embolized with coils. After the procedure, angiography revealed that the DAVF was cured with no residual shunting. This case demonstrates how minimally invasive surgery provides an alternative method to access a DVAF when conventional transarterial and/or transvenous embolization treatment options are not possible. Each DAVF case has unique anatomy and physiology, and creative multi-disciplinary strategies can often yield the best results.
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spelling pubmed-102958412023-06-28 Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report Withers, James Regenhardt, Robert W. Dmytriw, Adam A. Vranic, Justin E. Marciano, Rudolph Stapleton, Christopher J. Patel, Aman B. Brain Sci Case Report Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography revealed a Borden II/Cognard IIa+b DAVF. He underwent stage 1 transarterial embolization of the occipital artery which reduced shunting by 30%. Several attempts were made to access the fistula during stage 2 transvenous embolization, but it was not possible to access the left transverse sinus fistula site since there was no communication across the torcula from the right transverse sinus and the left inferior sigmoid–jugular bulb was occluded. Therefore, a single burr hole was drilled and direct access to the DAVF was achieved with a micropuncture needle under neuronavigational guidance. The left transverse–sigmoid sinus junction was then embolized with coils. After the procedure, angiography revealed that the DAVF was cured with no residual shunting. This case demonstrates how minimally invasive surgery provides an alternative method to access a DVAF when conventional transarterial and/or transvenous embolization treatment options are not possible. Each DAVF case has unique anatomy and physiology, and creative multi-disciplinary strategies can often yield the best results. MDPI 2023-05-27 /pmc/articles/PMC10295841/ /pubmed/37371351 http://dx.doi.org/10.3390/brainsci13060871 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Withers, James
Regenhardt, Robert W.
Dmytriw, Adam A.
Vranic, Justin E.
Marciano, Rudolph
Stapleton, Christopher J.
Patel, Aman B.
Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report
title Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report
title_full Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report
title_fullStr Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report
title_full_unstemmed Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report
title_short Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report
title_sort direct burr hole access for transverse–sigmoid junction davf embolization: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10295841/
https://www.ncbi.nlm.nih.gov/pubmed/37371351
http://dx.doi.org/10.3390/brainsci13060871
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