, 51:477 | Cite as

Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

  • M. Kirsch
  • T. Liebig
  • D. Kühne
  • H. HenkesEmail author
Interventional Neuroradiology



This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse–sigmoid sinus dural arteriovenous fistulas (TS_dAVF).


A total of 150 consecutive patients and 348 procedures were evaluated.


Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS_dAVFs. More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial (n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%).


Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful.


Dural arteriovenous fistula dAVF Endovascular Coil Embolization Transvenous 


Conflict of interest statement

We declare that we have no conflict of interest.


  1. 1.
    Awad IA, Little JR, Akarawi WP, Ahl J (1990) Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:839–850PubMedCrossRefGoogle Scholar
  2. 2.
    Barnwell SL, Halbach VV, Higashida RT, Hieshima G, Wilson CB (1989) Complex dural arteriovenous fistulas. Results of combined endovascular and neurosurgical treatment in 16 patients. J Neurosurg 71:352–358PubMedCrossRefGoogle Scholar
  3. 3.
    Brasse G, Roth HJ, Fritzsch D, Scheid R (2009) Now you see it, now you don't—the hidden life of cerebral dural arteriovenous fistulae. Neuroradiology 51:131–133PubMedCrossRefGoogle Scholar
  4. 4.
    Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, Chiras J, Merland JJ (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:671–680PubMedGoogle Scholar
  5. 5.
    Cognard C, Januel AC, Silva NA Jr, Tall P (2008) Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using onyx. AJNR Am J Neuroradiol 29:235–241PubMedCrossRefGoogle Scholar
  6. 6.
    da Costa LB, Terbrugge K, Farb R, Wallace MC (2007) Surgical disconnection of cortical venous reflux as a treatment for Borden type II dural arteriovenous fistulae. Acta Neurochir (Wien) 149:1103–1108CrossRefGoogle Scholar
  7. 7.
    Davies MA, TerBrugge K, Willinsky R, Coyne T, Saleh J, Wallace MC (1996) The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85:830–837PubMedCrossRefGoogle Scholar
  8. 8.
    Dawson RC 3rd, Joseph GJ, Owens DS, Barrow DL (1998) Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and sigmoid sinuses. AJNR Am J Neuroradiol 19:571–576PubMedGoogle Scholar
  9. 9.
    Debrun GM, Vinuela F, Fox AJ, Davis KR, Ahn HS (1988) Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery 22:285–289PubMedCrossRefGoogle Scholar
  10. 10.
    Endo S, Kuwayama N, Takaku A, Nishijima M (1998) Direct packing of the isolated sinus in patients with dural arteriovenous fistulas of the transverse–sigmoid sinus. J Neurosurg 88:449–456PubMedGoogle Scholar
  11. 11.
    Fok KF, Agid R, Souza MPS, terBrugge KG (2004) Thrombosis of aggressive dural arteriovenous fistula after incomplete embolization. Neuroradiology 46:1016–1021PubMedCrossRefGoogle Scholar
  12. 12.
    Gobin YP, Houdart E, Rogopoulos A, Casasco A, Bailly AL, Merland JJ (1993) Percutaneous transvenous embolization through the thrombosed sinus in transverse sinus dural fistula. AJNR Am J Neuroradiol 14:1102–1105PubMedGoogle Scholar
  13. 13.
    Goto K, Sidipratomo P, Ogata N, Inoue T, Matsuno H (1999) Combining endovascular and neurosurgical treatments of high-risk dural arteriovenous fistulas in the lateral sinus and the confluence of the sinuses. J Neurosurg 90:289–299PubMedCrossRefGoogle Scholar
  14. 14.
    Halbach VV, Higashida RT, Hieshima GB, Goto K, Norman D, Newton TH (1987) Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology 163:443–447PubMedGoogle Scholar
  15. 15.
    Halbach VV, Higashida RT, Hieshima GB, Mehringer CM, Hardin CW (1989) Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses. AJNR Am J Neuroradiol 10:385–392PubMedGoogle Scholar
  16. 16.
    Halbach VV, Higashida RT, Hieshima GB, Wilson CB, Hardin CW, Kwan E (1989) Treatment of dural fistulas involving the deep cerebral venous system. AJNR Am J Neuroradiol 10:393–399PubMedGoogle Scholar
  17. 17.
    He HW, Jiang CH, Wu ZX, Li YX, Lü XL, Wang ZC (2008) Transvenous embolization with a combination of detachable coils and onyx for a complicated cavernous dural arteriovenous fistula. Chin Med J (Engl) 121:1651–1655Google Scholar
  18. 18.
    Jiang C, Lv X, Li Y, Zhang J, Wu Z (2009) Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes. Neuroradiology 51:103–111PubMedCrossRefGoogle Scholar
  19. 19.
    Kakarla UK, Deshmukh VR, Zabramski JM, Albuquerque FC, McDougall CG, Spetzler RF (2007) Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications. Neurosurgery 61:447–457PubMedCrossRefGoogle Scholar
  20. 20.
    Kataoka K, Taneda M (1984) Angiographic disappearance of multiple dural arteriovenous malformations. Case report. J Neurosurg 60:1275–1278PubMedCrossRefGoogle Scholar
  21. 21.
    Kawaguchi S, Sakaki T, Morimoto T, Hoshida T, Nakase H (2000) Surgery for dural arteriovenous fistula in superior sagittal sinus and transverse sigmoid sinus. J Clin Neurosci 7(Suppl 1):47–49PubMedGoogle Scholar
  22. 22.
    Kim MS, Han DH, Kwon OK, Oh CW, Han MH (2002) Clinical characteristics of dural arteriovenous fistula. J Clin Neurosci 9:147–155PubMedCrossRefGoogle Scholar
  23. 23.
    King WA, Martin NA (1992) Intracerebral hemorrhage due to dural arteriovenous malformations and fistulae. Neurosurg Clin N Am 3:577–590PubMedGoogle Scholar
  24. 24.
    Kiyosue H, Hori Y, Okahara M, Tanoue S, Sagara Y, Matsumoto S, Nagatomi H, Mori H (2004) Treatment of intracranial dural arteriovenous fistulas: current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. Radiographics 24:1637–1653PubMedCrossRefGoogle Scholar
  25. 25.
    Landman JA, Braun IF (1985) Spontaneous closure of a dural arteriovenous fistula associated with acute hearing loss. AJNR Am J Neuroradiol 6:448–449PubMedGoogle Scholar
  26. 26.
    Liebig T, Henkes H, Brew S, Miloslavski E, Kirsch M, Kühne D (2005) Reconstructive treatment of dural arteriovenous fistulas of the transverse and sigmoid sinus: transvenous angioplasty and stent deployment. Neuroradiology 47:543–551PubMedCrossRefGoogle Scholar
  27. 27.
    Link MJ, Coffey RJ, Nichols DA, Gorman DA (1996) The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. J Neurosurg 84:804–809PubMedCrossRefGoogle Scholar
  28. 28.
    Luciani A, Houdart E, Mounayer C, Saint Maurice JP, Merland JJ (2001) Spontaneous closure of dural arteriovenous fistulas: report of three cases and review of the literature. AJNR Am J Neuroradiol 22:992–996PubMedGoogle Scholar
  29. 29.
    Mironov A (1995) Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR Am J Neuroradiol 19:389–391Google Scholar
  30. 30.
    Mullan S, Johnson DL (1995) Combined sagittal and lateral sinus dural fistulae occlusion. J Neurosurg 82:159–165PubMedCrossRefGoogle Scholar
  31. 31.
    Murphy KJ, Gailloud P, Venbrux A, Deramond H, Hanley D, Rigamonti D (2000) Endovascular treatment of a grade IV transverse sinus dural arteriovenous fistula by sinus recanalization, angioplasty, and stent placement: technical case report. Neurosurgery 46:497–501PubMedCrossRefGoogle Scholar
  32. 32.
    Nelson PK, Russell SM, Woo HH, Alastra AJ, Vidovich DV (2003) Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients. J Neurosurg 98:498–506PubMedCrossRefGoogle Scholar
  33. 33.
    Newton TH, Cronqvist S (1969) Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93:1071–1078PubMedGoogle Scholar
  34. 34.
    Nogueira RG, Dabus G, Rabinov JD, Eskey CJ, Ogilvy CS, Hirsch JA, Pryor JC (2008) Preliminary experience with onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol 29:91–97PubMedCrossRefGoogle Scholar
  35. 35.
    O'Leary S, Hodgson TJ, Coley SC, Kemeny AA, Radatz MWR (2002) Intracranial dural arteriovenous malformations: results of stereotactic radiosurgery in 17 patients. Clin Oncol (R Coll Radiol) 14:97–102Google Scholar
  36. 36.
    Olutola PS, Eliam M, Molot M, Talalla A (1983) Spontaneous regression of a dural arteriovenous malformation. Neurosurgery 12:687–690PubMedCrossRefGoogle Scholar
  37. 37.
    Pan DH, Chung W, Guo W, Wu H, Liu K, Shiau C, Wang L (2002) Stereotactic radiosurgery for the treatment of dural arteriovenous fistulas involving the transverse–sigmoid sinus. J Neurosurg 96:823–829PubMedCrossRefGoogle Scholar
  38. 38.
    Panagiotopoulos V, Möller-Hartmann W, Asgari S, Sandalcioglu IE, Forsting M, Wanke I (2009) Onyx embolization as a first line treatment for intracranial dural arteriovenous fistulas with cortical venous reflux. Fortschr Röntgenstr 181:129–138CrossRefGoogle Scholar
  39. 39.
    Sundt TM Jr, Nichols DA, Piepgras DG, Fode NC (1991) Strategies, techniques, and approaches for dural arteriovenous malformations of the posterior dural sinuses. Clin Neurosurg 37:155–170PubMedGoogle Scholar
  40. 40.
    Thompson BG, Doppman JL, Oldfield EH (1994) Treatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage. J Neurosurg 80:617–623PubMedCrossRefGoogle Scholar
  41. 41.
    Urtasun F, Biondi A, Casaco A, Houdart E, Caputo N, Aymard A, Merland JJ (1996) Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization. Radiology 199:209–217PubMedGoogle Scholar
  42. 42.
    Wong GKC, Poon WS, Yu SCH, Zhu CXL (2007) Transvenous embolization for dural transverse sinus fistulas with occluded sigmoid sinus. Acta Neurochir (Wien) 149:929–935CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Institut für Diagnostische Radiologie und NeuroradiologieErnst-Moritz-Arndt-Universität GreifswaldGreifswaldGermany
  2. 2.Institut für Neuroradiologie, Klinikum Rechts der IsarTU MünchenMunichGermany
  3. 3.Klinik für Radiologie und Neuroradiologie, Alfried-Krupp-KrankenhausEssenGermany
  4. 4.Klinik für NeuroradiologieKatharinenhospital-Klinikum StuttgartStuttgartGermany

Personalised recommendations