Combined Trans-arterial and Balloon-Assisted Transvenous Onyx Embolization of Dural AVF

Abstract

A 30-year-old man presented with history of blurring of vision of both eyes since one and half years. Ophthalmological evaluation had revealed bilateral papilloedema. MRI had showed cerebral sino-venous thrombosis (CVT) involving the right transverse sinus and superior sagittal sinus, and he was treated with anticoagulants. Subsequently he developed tinnitus in the right ear. Repeat MRI and MRA revealed dural AV fistula of the right transverse sinus. Cerebral angiography (Fig. 62.1a–e) showed high flow dural AV fistula of the right transverse sinus supplied by multiple transosseous hypertrophied branches of bilateral occipital arteries, parietal branch of right MMA, and small contribution from meningo-hypophyseal trunk from the right ICA and dural branch of the right AICA. Occlusion of the right transverse sinus at the junction with sigmoid sinus with contrast reflux into the torcula, straight sinus, superior sagittal sinus, and left transverse-sigmoid sinus was noted. No obvious cortical venous reflux was seen. The right cerebral hemisphere was seen to have venous drainage into the left transverse sinus except the vein of Labbe which was draining into the right transverse sinus.