ABSTRACT
Transverse-sigmoid sinus dural arteriovenous malformations (DAVM) are uncommon vascular
lesions for which complete cure may be difficult to obtain. A wide variety of treatments
for these lesions include observation, arterial compression, surgical resection, and
endovascular embolization. We propose that transverse-sigmoid sinus DAVM can be completely
cured by occluding the ipsilateral dural sinus with detachable balloon and Guglielmi
detachable coils (GDC) coils before arterial feeder embolization with histoacryl.
Three patients who presented with pulsatile tinnitus and normal magnetic resonance
imaging (MRI) studies underwent angiography, which demonstrated transverse-sigmoid
sinus DAVM. All three patients were treated with retrograde transvenous sinus embolization
with complete occlusion of the transverse-sigmoid sinus with detachable balloons and
GDC coils with preservation of the vein of Labbé. Subsequently, the various feeders
from the external carotid artery were embolized. The tentorial arteries arising from
the ipsilateral internal carotid arteries were not embolized in any of the cases,
which were still contributing to the DAVM. Complete cure with thrombosis of the tentorial
branch of the internal carotid artery (ICA) was seen on follow-up angiogram 1 day
after embolization in one patient and on 4-week and 6-week follow-up angiograms in
the other two patients. Complete occlusion of the transverse sinus proximal to the
vein of Labbé, in spite of incomplete arterial feeder embolization, can result in
complete cure of the transverse sinus dural AVF if adequate time is given for the
remaining feeders to occlude, once the fistula is obliterated.
KEYWORD
AVM - endovascular treatment - tinnitis
