The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas.
OBJECTIVE
To evaluate the role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas (DAVFs), including its efficacy and safety.


METHODS
We retrospectively studied the charts of 24 patients (21 women and 3 men) treated for an intracranial DAVF since 1990 in whom a transvenous approach was attempted either alone (16 patients) or in combination with arterial embolization (8 patients). There were 12 cavernous sinus, 9 transverse-sigmoid sinus, 2 inferior petrosal sinus, and 1 intradiploic fistulas. Three fistulas were Type I, 12 were Type IIa, and 9 were Type IIa+b, according to the revised Djindjian's classification. Transvenous embolic agents included coils (17 patients), detachable balloons (6 patients), bucrylate (2 patients), and silk sutures (1 patient).


RESULTS
Anatomic cure was proven in 21 patients (87.5%). Clinical cure was obtained in 23 cases (96%), as follows: 15 patients with a single transvenous approach, 6 with a combined arteriovenous approach, and 2 with an arterial approach after failure of venous access. There was one persistent cavernous fistula despite coil packing of the cavernous sinus. Complications were as follows: five transient and one permanent sixth nerve palsies in cavernous DAVFs, two transient labyrinthic dysfunctions in transverse sinus DAVFs, and one subarachnoid hemorrhage without sequelae.


CONCLUSIONS
Transvenous embolization is a useful and safe approach in the management of intracranial DAVFs.
Roy
D
D
Department of Radiology, Hôpital Notre-Dame, Université de Montréal, Quebec, Canada.
Raymond
J
J
D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000628:therapy*; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000293:injuries*; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D005268:Femoral Vein; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome