Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report
Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography reveale...
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| Format: | Article |
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MDPI AG
2023-05-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/13/6/871 |
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| author | James Withers Robert W. Regenhardt Adam A. Dmytriw Justin E. Vranic Rudolph Marciano Christopher J. Stapleton Aman B. Patel |
| author_facet | James Withers Robert W. Regenhardt Adam A. Dmytriw Justin E. Vranic Rudolph Marciano Christopher J. Stapleton Aman B. Patel |
| author_sort | James Withers |
| collection | DOAJ |
| description | Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography revealed a Borden II/Cognard IIa+b DAVF. He underwent stage 1 transarterial embolization of the occipital artery which reduced shunting by 30%. Several attempts were made to access the fistula during stage 2 transvenous embolization, but it was not possible to access the left transverse sinus fistula site since there was no communication across the torcula from the right transverse sinus and the left inferior sigmoid–jugular bulb was occluded. Therefore, a single burr hole was drilled and direct access to the DAVF was achieved with a micropuncture needle under neuronavigational guidance. The left transverse–sigmoid sinus junction was then embolized with coils. After the procedure, angiography revealed that the DAVF was cured with no residual shunting. This case demonstrates how minimally invasive surgery provides an alternative method to access a DVAF when conventional transarterial and/or transvenous embolization treatment options are not possible. Each DAVF case has unique anatomy and physiology, and creative multi-disciplinary strategies can often yield the best results. |
| first_indexed | 2024-03-11T02:41:11Z |
| format | Article |
| id | doaj.art-de9d797f34f5429bb80725f4d7a8156c |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-11T02:41:11Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-de9d797f34f5429bb80725f4d7a8156c2023-11-18T09:35:43ZengMDPI AGBrain Sciences2076-34252023-05-0113687110.3390/brainsci13060871Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case ReportJames Withers0Robert W. Regenhardt1Adam A. Dmytriw2Justin E. Vranic3Rudolph Marciano4Christopher J. Stapleton5Aman B. Patel6College of Osteopathic Medicine, University of New England, Biddeford, ME 04005, USADepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USADepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USADepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USANorthern Light Neurosurgery and Spine, Bangor, ME 04401, USADepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USADepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USADural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography revealed a Borden II/Cognard IIa+b DAVF. He underwent stage 1 transarterial embolization of the occipital artery which reduced shunting by 30%. Several attempts were made to access the fistula during stage 2 transvenous embolization, but it was not possible to access the left transverse sinus fistula site since there was no communication across the torcula from the right transverse sinus and the left inferior sigmoid–jugular bulb was occluded. Therefore, a single burr hole was drilled and direct access to the DAVF was achieved with a micropuncture needle under neuronavigational guidance. The left transverse–sigmoid sinus junction was then embolized with coils. After the procedure, angiography revealed that the DAVF was cured with no residual shunting. This case demonstrates how minimally invasive surgery provides an alternative method to access a DVAF when conventional transarterial and/or transvenous embolization treatment options are not possible. Each DAVF case has unique anatomy and physiology, and creative multi-disciplinary strategies can often yield the best results.https://www.mdpi.com/2076-3425/13/6/871DAVFdural arteriovenous fistulaneurosurgeryburr holeendovascular surgery |
| spellingShingle | James Withers Robert W. Regenhardt Adam A. Dmytriw Justin E. Vranic Rudolph Marciano Christopher J. Stapleton Aman B. Patel Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report Brain Sciences DAVF dural arteriovenous fistula neurosurgery burr hole endovascular surgery |
| title | Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report |
| title_full | Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report |
| title_fullStr | Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report |
| title_full_unstemmed | Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report |
| title_short | Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report |
| title_sort | direct burr hole access for transverse sigmoid junction davf embolization a case report |
| topic | DAVF dural arteriovenous fistula neurosurgery burr hole endovascular surgery |
| url | https://www.mdpi.com/2076-3425/13/6/871 |
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