Endovascular Approach and Technique for Treatment of TransverseSigmoid Dural Arteriovenous Fistula with Cortical Reflux: The Importance of Venous Sinus Sacrifice

Introduction: Treatment of dural arteriovenous fistula involving the transverse‐igmoid region with cortical reflux is complex; treatment options may require s sacrifice of the fistulous segment of sinus. Methods: We reviewed cases of endovascular sinus sacrifice for dural fistulae at our nstitution from 2007‐2012. Demographic, decision‐making, technical, and outcome i data were collected. Results: Seven patients were identified who underwent endovascular sinus sacrifice for treatment of dural fistula during this 4 year period. Determination of the fistulous sinus segment was based on the pattern of cortical venous drainage. Endovascular access to the sinus was achieved trans‐arterial, transvenous, or via open surgery in one case. Complete cure of the target fistula was obtained in all cases. One patient had transient post‐procedure headache. There were no emorrhages, new neurological deficits, or sign of increased intracranial pressure. h 6/7 patients had angiographic follow up at least 6 months with no recurrence. Conclusion: Fistulas of the transverse‐sigmoid sinuses with cortical reflux may require sacrifice of the parent sinus for cure. Defining the fistulous segment and occluding this segment deliberately, completely and precisely is essential for cure. Several modalities and approaches can be used to achieve this. For properly selected patients, cure of the lesions can be achieved with this method with low risk of morbidity.