Transarterial Embolization of Straight Sinus Dural Arteriovenous Fistula

Patient

• 70-year-old male presented with sudden onset headache, and nausea and significant dizziness and ataxia resulting in a fall at home
• R-sided dysmetria, left CN VI palsy with diplopia
• PMHx: DM2; HTN; gout

CT/CTA

DSA: Right ECA

DSA: Right ICA

DSA: Left ECA

Left VA Including L SCA Microcatheter Exploration

DSA: Right VA

DSA 3D

• Straight sinus single-hole DAVF with drainage into a parasinus

• Borden III: CVR and venous ectatic pouches

•  Endovascular treatment as first-line

– Ease of access to fistulous point–Blood loss is not a factor–Immediate confirmation of cureTransarterial vs Transvenous

• Both viable options

• Goals of treatment:

– Disconnection of fistulous point–Prevent significant reflux / efflux into arterial feeders–Prevent occlusion of normal venous anatomy (straight sinus)Transarterial Embolization

• Steps:

1.Coiling of scalp branch to prevent catheter herniation during navigation: SL-10

2.Transarterial navigation to fistula: 165 cm Marathon microcatheter and Fargo Mini intermediate catheter

3.Onyx-18 Embolization

   Treatment Progression

Post-Embolization L VA

Clinical Course

• Clinically stable
• Persistent dizziness and headaches in hospital with gradual recovery
• Eventual discharge home
• Awaiting follow-up DSA to confirm cure