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. 2001;11(1):13–23. doi: 10.1055/s-2001-12782

Endovascular Treatment of Transverse-Sigmoid Sinus Dural Arteriovenous Malformations Presenting as Pulsatile Tinnitus

Harish Shownkeen, Kevin Yoo, John Leonetti, TC Origitano
PMCID: PMC1656835  PMID: 17167600

Abstract

Transverse-sigmoid sinus dural arteriovenous malformations (DAVM) are uncommon vascular lesions for which complete cure may be difficult to obtain. A wide variety of treatments for these lesions include observation, arterial compression, surgical resection, and endovascular embolization. We propose that transverse-sigmoid sinus DAVM can be completely cured by occluding the ipsilateral dural sinus with detachable balloon and Guglielmi detachable coils (GDC) coils before arterial feeder embolization with histoacryl. Three patients who presented with pulsatile tinnitus and normal magnetic resonance imaging (MRI) studies underwent angiography, which demonstrated transverse-sigmoid sinus DAVM. All three patients wer treated with retrograde transvenous sinus embolization with complete occlusion of the transverse-sigmoid sinus with detachable balloons and GDC coils with preservation of the vein of Labbé. Subsequently, the various feeders from the external carotid artery were embolized. The tentorial arteries arising from the ipsilateral internal carotid arteries were not embolized in any of the cases, which were still contributing to the DAVM. Complete cure with thrombosis of the tentorial branch of the internal carotid artery (ICA) was seen on follow-up angiogram 1 day after embolization in one patient and on 4-week and 6-week follow-up angiograms in the other two patients. Complete occlusion of the transverse sinus proximal to the vein of Labbé, in spite of incomplete arterial feeder embolization, can result in complete cure of the transversesinus dural AVF if adequate time is given for the remaining feeders to occlude, once the fistula is obliterated.

Keywords: AVM, endovascular treatment, tinnitis

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ApSimon H. T., Ives F. J., Khangure M. S. Cranial dural arteriovenous malformation and fistula. Radiological diagnosis and management. Review of thirty four patients. Australas Radiol. 1993 Feb;37(1):2–25. doi: 10.1111/j.1440-1673.1993.tb00001.x. [DOI] [PubMed] [Google Scholar]
  2. Bavinzski G., Richling B., Killer M., Gruber A., Levy D. Evolution of different therapeutic strategies in the treatment of cranial dural arteriovenous fistulas--report of 30 cases. Acta Neurochir (Wien) 1996;138(2):132–138. doi: 10.1007/BF01411351. [DOI] [PubMed] [Google Scholar]
  3. Bitoh S., Sakaki S. Spontaneous cure of dural arteriovenous malformation in the posterior fossa. Surg Neurol. 1979 Aug;12(2):111–114. [PubMed] [Google Scholar]
  4. Borden J. A., Wu J. K., Shucart W. A. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg. 1995 Feb;82(2):166–179. doi: 10.3171/jns.1995.82.2.0166. [DOI] [PubMed] [Google Scholar]
  5. Cognard C., Gobin Y. P., Pierot L., Bailly A. L., Houdart E., Casasco A., Chiras J., Merland J. J. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995 Mar;194(3):671–680. doi: 10.1148/radiology.194.3.7862961. [DOI] [PubMed] [Google Scholar]
  6. Endo S., Koshu K., Suzuki J. Spontaneous regression of posterior fossa dural arteriovenous malformation. J Neurosurg. 1979 Nov;51(5):715–717. doi: 10.3171/jns.1979.51.5.0715. [DOI] [PubMed] [Google Scholar]
  7. Halbach V. V., Higashida R. T., Hieshima G. B., Goto K., Norman D., Newton T. H. Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology. 1987 May;163(2):443–447. doi: 10.1148/radiology.163.2.3562824. [DOI] [PubMed] [Google Scholar]
  8. Halbach V. V., Higashida R. T., Hieshima G. B., Mehringer C. M., Hardin C. W. Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses. AJNR Am J Neuroradiol. 1989 Mar-Apr;10(2):385–392. [PMC free article] [PubMed] [Google Scholar]
  9. Ito Y., Fukumura A., Seto H., Ikeda J., Matsukado Y., Kodama T. [Internal carotid aneurysmal formation following spontaneous regression of the dural arteriovenous malformation in the posterior fossa--a case report]. No Shinkei Geka. 1985 Nov;13(11):1215–1220. [PubMed] [Google Scholar]
  10. Kurl S., Vanninen R., Saari T., Hernesniemi J. Development of right transverse sinus dural arteriovenous malformation after embolisation of a similar lesion on the left. Neuroradiology. 1996 May;38(4):386–388. doi: 10.1007/BF00596598. [DOI] [PubMed] [Google Scholar]
  11. Kutluk K., Schumacher M., Mironov A. The role of sinus thrombosis in occipital dural arteriovenous malformations--development and spontaneous closure. Neurochirurgia (Stuttg) 1991 Sep;34(5):144–147. doi: 10.1055/s-2008-1052075. [DOI] [PubMed] [Google Scholar]
  12. Lalwani A. K., Dowd C. F., Halbach V. V. Grading venous restrictive disease in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus. J Neurosurg. 1993 Jul;79(1):11–15. doi: 10.3171/jns.1993.79.1.0011. [DOI] [PubMed] [Google Scholar]
  13. Magidson M. A., Weinberg P. E. Spontaneous closure of a dural arteriovenous malformation. Surg Neurol. 1976 Aug;6(2):107–110. [PubMed] [Google Scholar]
  14. Okuizumi K., Watanabe K., Yamazaki M., Koike T., Onishi Y. [A case of dural arteriovenous malformation associated with progressive dementia showing marked improvement with endovascular treatment]. Rinsho Shinkeigaku. 1998 Feb;38(2):112–117. [PubMed] [Google Scholar]
  15. Pritz M. B., Pribram H. F. Spontaneous closure of a high-risk dural arteriovenous malformation of the transverse sinus. Surg Neurol. 1991 Sep;36(3):226–228. doi: 10.1016/0090-3019(91)90118-s. [DOI] [PubMed] [Google Scholar]
  16. Rohr J., Gauthier G. Régression spontanée d'une fistule artérioveineuse dure-mérienne de la fosse postérieure. Rev Neurol (Paris) 1985;141(3):240–244. [PubMed] [Google Scholar]
  17. Roy D., Lavigne F., Raymond J. Pulsatile tinnitus and dural arteriovenous fistula of the transverse sinus. J Otolaryngol. 1993 Dec;22(6):409–412. [PubMed] [Google Scholar]
  18. Roy D., Raymond J. The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery. 1997 Jun;40(6):1133–1144. doi: 10.1097/00006123-199706000-00004. [DOI] [PubMed] [Google Scholar]
  19. Shah S. B., Lalwani A. K., Dowd C. F. Transverse/sigmoid sinus dural arteriovenous fistulas presenting as pulsatile tinnitus. Laryngoscope. 1999 Jan;109(1):54–58. doi: 10.1097/00005537-199901000-00012. [DOI] [PubMed] [Google Scholar]
  20. Urtasun F., Biondi A., Casaco A., Houdart E., Caputo N., Aymard A., Merland J. J. Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization. Radiology. 1996 Apr;199(1):209–217. doi: 10.1148/radiology.199.1.8633147. [DOI] [PubMed] [Google Scholar]

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