Fig 4.

Left transvers sinus DAVFs (type IIa+b) with left sigmoid sinus occlusion. Frontal (A) and lateral (B and C) views of the left external carotid angiography show DAVFs diffusely involving the left transverse sinus. The DAVFs are fed by the left occipital artery and the convexity branch of the middle meningeal artery and drain retrogradely into the contralateral transverse sinus, the straight sinus, and the left temporal vein (vein of Labbé). D, Frontal view of the right external carotid artery shows DAVFs at the sinus confluence fed by multiple branches of the occipital artery. E, Axial reformatted images of rotational angiography of the left external carotid artery show shunted pouches (white arrows) that are located inferodorsally to the distal transverse sinus. The shunted pouches were fed by numerous transosseous branches of the occipital artery (TOB). F, Axial reformatted images of rotational angiography of the right external carotid artery show another shunted pouch (white arrows) that is located inferodorsally to the sinus confluence. The shunted pouches were fed by multiple TOBs. G, Selective venography via a microcatheter navigated through the occluded sigmoid sinus shows a shunted venous pouch inferior to the transverse sinus. Each shunted pouch was selectively catheterized and embolized with coils. Right (H) and left (I) external carotid angiography after selective transvenous embolization shows the disappearance of the DAVFs. J, Left internal carotid angiography during the venous phase 10 days after embolization shows coils placed inferior to the transverse sinus and preserved and reconstructed venous flow in the transverse-sigmoid sinus. Note the normalized venous flow of the vein of Labbé antegradely into the transverse sinus.