Triple-catheter technique in the transvenous coil embolization of an isolated sinus dural arteriovenous fistula.
OBJECTIVE
Dural arteriovenous fistulae involving the transverse-sigmoid sinus, which is occluded at its proximal and distal ends (i.e., an isolated sinus), carry a high risk of intracranial hemorrhage or progressive neurological deficits. Although transvenous coil embolization is a useful and safe treatment for such lesions, it is often difficult to reach into the isolated sinus through the occluded sinus using the percutaneous catheter approach.


METHODS
We report the successful treatment of two patients with transverse-sigmoid dural arteriovenous fistulae with isolated sinus using the percutaneous transvenous triple-catheter technique. A 6-French guiding catheter was placed at the internal jugular vein followed by a second 4-French catheter positioned at the end of the occluded sinus. A third microcatheter was then navigated into the isolated sinus with support of the second catheter.


RESULTS
Although initial attempts to reach into the isolated sinus without the second catheter failed, insertion of the second catheter resulted in successful navigation of the third microcatheter into the affected sinus in both cases. Complete cure was obtained in both cases by coil packing of the affected sinus.


CONCLUSIONS
Although careful maneuvering is required, this triple-catheter technique is useful for treatment of dural arteriovenous fistulae with isolated sinus.
Sugiu
Kenji
K
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. ksugiu@md.okayama-u.ac.jp
Tokunaga
Koji
K
Nishida
Ayumi
A
Sasahara
Wataru
W
Watanabe
Kyoichi
K
Ono
Shigeki
S
Onoda
Keisuke
K
Date
Isao
I
D000368:Aged; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome