Cognard Type V Dural Arteriovenous Fistula Involving the Occipital Sinus.
The Cognard type V dural arteriovenous fistula (dAVF), which has a drainage route into the spinal vein, is a rare subtype of cranial dAVF. Because of typical features such as progressive myelopathy and brainstem dysfunctions, aggressive treatments should be considered. To eliminate venous congestion of the spinal cord, various approaches including surgical interruption of the spinal draining vein or transarterial embolization with cyanoacrylate have been reported. The introduction of nonadhesive Onyx has changed the treatment of dAVF, although little is known about the clinical usefulness of this type of fistula. We describe a case of the Cognard type V dAVF, draining into the spinal vein through the occipital sinus (OS) successfully treated by transarterial double catheter injection of Onyx. We used the alternating injections from 2 microcatheters until the Onyx reached the OS and reflowed into feeders adequately. This technique contributed to the elimination of the remaining afferent flow in an early stage of Onyx injection and achieved enough penetration into the draining vein.
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: jun_flatout@yahoo.co.jp.
Jun
J
Tanaka
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Atsushi
A
Fujita
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Masahiro
M
Maeyama
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Masaaki
M
Kohta
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Kohkichi
K
Hosoda
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Eiji
E
Kohmura
D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D004121:Dimethyl Sulfoxide / Q000378:metabolism; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000378:metabolism
C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
Cognard type V dAVF; Onyx; double catheter; transarterial embolization