Surgical Burr Hole Access for Direct Sinus Puncture and Transvenous Coil Embolization of a Complex Superior Sagittal Sinus Dural Arteriovenous Fistula.

Abstract

Dural arteriovenous fistulas (dAVFs) account for 10-15% of all cerebral vascular malformations,1 and their location around the superior sagittal sinus is rare with an incidence of 4-11% of all dAVFs.2 Endovascular transarterial or transvenous embolization are the treatment routes of choice for dAVFs,3 but in rare cases direct sinus access may be favorable.4 5 We present an unusual case of a complex superior sagittal sinus dAVF with multiple arterial feeders and an occluded posterior superior sagittal sinus segment which was challenging for classic embolization routes. A combined surgical and endovascular approach in the hybrid biplane operating room was performed and is shown in video 1 By using a direct surgical burr hole for sinus access anterior to the dAVF and the thrombosed sinus portion followed by transvenous coil embolization, the dAVF was cured in a minimally invasive and safe fashion.neurintsurg;jnis-2023-020774v1/V1F1V1Video 1Treatment of a complex superior sagittal sinus dural arteriovenous fistula by surgical burr hole access for direct sinus puncture and transvenous coil embolization.

• Authors: Paz Kelmer, Georgios S Sioutas, Mohamed M Salem, Visish M Srinivasan, Jan Karl Burkhardt
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) (Aug 23 2023) ISSN: 1759-8486 [Electronic] England
• PMID: 37611939 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.