title: Successful sinus restoration for transverse-sigmoid sinus dural arteriovenous fistula complicated by multiple venous sinus occlusions: The usefulness of preoperative computed tomography venography.
abstract: BACKGROUND
  Although sinus restoration for transverse-sigmoid sinus (TSS) dural arteriovenous fistula (DAVF) has rarely been reported over the past decade, its advantage and indication still remain unclear. Herein, we discuss the indications and technical aspects of this therapy with a review of the literature.
  
  
  METHODS
  A 79-year-old female was referred to our department with generalized convulsion. An angiogram revealed a DAVF at the junction of the right TSS. The right sigmoid and left transverse sinuses were occluded, which resulted in remarkable leptomeningeal venous reflux and cerebral venous congestion. A preoperative computed tomography (CT) venogram precisely revealed the occluded segment of the right sigmoid sinus, which facilitated the sinus restoration with balloon percutaneous transluminal angioplasty and stenting.
  
  
  CONCLUSIONS
  Sinus restoration is preferable in patients with severe cerebral venous congestion due to multiple sinus occlusions and/or a restricted collateral venous outlet. CT venography is useful for precise evaluation of the length and configuration of the occluded segment, which thus make it possible to evaluate the feasibility of stenting.
authors.affiliation: Department of Neurosurgery, Sasebo Chuo Hospital, Nagasaki, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Takemoto
authors.affiliation: Department of Neurosurgery, Fukuoka University Hospital and Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Higashi
authors.affiliation: Department of Neurosurgery, Sasebo Chuo Hospital, Nagasaki, Japan.
authors.forename: Seisaburo
authors.initials: S
authors.lastname: Sakamoto
authors.affiliation: Department of Neurosurgery, Fukuoka University Hospital and Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
keywords: Computed tomography venography; dural arteriovenous fistula; sinus restoration; stent; transverse-sigmoid sinus