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Endovascular Treatment of Borden Type III Transverse-sigmoid Sinus Dural Arteriovenous Fistulas: a Single-center 12-year Experience

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Abstract

Purpose

The objective of this study was to evaluate our 12-year experience in treating Borden type III transverse-sigmoid sinus (TSS) dural arteriovenous fistulas (DAVFs) and discuss the technical aspects of ipsilateral and contralateral transvenous embolization (TVE) approaches.

Methods

We retrospectively reviewed charts of consecutive patients with TSS DAVF treated with multimodal treatment between April 2008 and March 2020. The baseline patient characteristics, imaging data, details of procedure, data sets of sinus pressure monitoring, and clinical results were systematically collected.

Results

Of 44 patients with TSS DAVF who were treated during study periods, 23 patients of Borden type III were extracted. Among the 23 patients, 18 with transfemoral TVE were included for analysis. TVE was performed using an ipsilateral approach in 8 patients and a contralateral approach in 10. Pressure monitoring data revealed that initial mean sinus pressure (43.5 mmHg vs. 29.5 mmHg; P = 0.033), maximum sinus pressure during the procedure (69.0 mmHg vs. 40.5 mmHg; P = 0.011), and sinus pressure gradient (22.5 mmHg vs. 5.5 mmHg; P = 0.021) were significantly higher in the ipsilateral approach group. The complete obliteration rate by primary embolization was 94% in our cohort with the recurrence rate of 5.6% with a median follow-up period of 57 months.

Conclusion

Our study showed the durability of TVE for patients with Borden type III TSS DAVF. TVE performed via the contralateral approach might prevent a potentially dangerous increase in intraprocedural sinus pressure and cortical venous reflux.

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Abbreviations

CTA:

Computed tomography angiography

CVR:

Cortical venous reflux

DAVF:

Dural arteriovenous fistula

DSA:

Digital subtraction angiography

IQR:

Interquartile range

MRA:

Magnetic resonance angiography

MSP:

Mean sinus pressure

SAD:

Skin-absorbed dose

SPG:

Sinus pressure gradient

TAE:

Transarterial embolization

TSS:

Transverse-sigmoid sinus

TVE:

transvenous embolization

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Acknowledgements

The authors would like to thank all other staff, neurosurgeons, and radiologists of Kobe University Hospital.

Funding

The authors have no personal, financial, or institutional interest in any of the drugs, materials, and devices described in this article.

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Authors and Affiliations

  1. Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan

    Atsushi Fujita, Masaaki Kohta, Takashi Sasayama & Eiji Kohmura

Authors
  1. Atsushi Fujita
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  2. Masaaki Kohta
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  3. Takashi Sasayama
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  4. Eiji Kohmura
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by A. Fujita, M. Kohta. The project was directed and supervised by T. Sasayama and E. Kohmura. The first draft of the manuscript was written by A. Fujita and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscripts.

Corresponding author

Correspondence to Atsushi Fujita.

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Conflict of interest

A. Fujita, M. Kohta, T. Sasayama and E. Kohmura declare that they have no competing interests.

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Fujita, A., Kohta, M., Sasayama, T. et al. Endovascular Treatment of Borden Type III Transverse-sigmoid Sinus Dural Arteriovenous Fistulas: a Single-center 12-year Experience. Clin Neuroradiol 33, 161–169 (2023). https://doi.org/10.1007/s00062-022-01197-4

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  • DOI: https://doi.org/10.1007/s00062-022-01197-4

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