Article Figures & Data
Figures
- Figure 1
Transarterial embolisation with two-microcatheter technique of a left sigmoid sinus dural arteriovenous fistula (dAVF) with precipitating hydrophobic injectable liquid (PHIL). (A) Lateral projection pre-embolisation angiogram, selective left occipital artery (OA) injection and (B) left main trunk external carotid artery injection showing multiple arterial feeders arising from the OA (solid black arrow) and middle meningeal artery (MMA) (solid white arrow), draining into a common channel (dotted black arrow). (C) Lateral road map angiogram showing dual microcatheter technique with positioning of Headway Duo microcatheter within the MMA (dashed white arrow) and Scepter C 4×10 mm balloon microcatheter in the OA (dashed black arrow). (D) Unsubtracted lateral view showing PHIL cast (dotted white arrow) after single infusion through the MMA with inflation of the Scepter balloon (dotted dashed black arrow) to reduce dAVF flow. (E) Final PHIL cast (dotted white arrow) following infusion through the MMA and OA. (F) Final lateral digital subtraction angiography (DSA), left common carotid injection showing no residual dAVF.
- Figure 2
Combined transarterial and transvenous embolisation of a left transverse sinus dural arteriovenous fistula (dAVF) with Onyx and microcoils. (A) Lateral projection pre-embolisation angiogram, selective left external carotid artery (ECA) injection and (B) right vertebral artery (VA) injection showing multiple arterial feeders arising from the left middle meningeal artery (MMA) (solid white arrow), right occipital artery (solid black arrow), right posterior meningeal artery (clear white arrow) and left artery of Davidoff and Schechter (dotted white dashed arrow), draining into a common channel (dotted black arrow). (C) Left ECA injection showing Scepter XC 4×11 mm microcatheter positioned within the MMA (dashed white arrow). (D) Anteroposterior (AP) road map showing Echelon 14 microcatheter positioned through the left transverse sinus and within the venous pouch (clear black arrow). Unsubtracted lateral view, (E) showing successful deployment of microcoils within the venous pouch (dotted black dashed arrow), (F) showing the Onyx cast after successful infusion through the MMA (dotted white arrow). Postembolisation lateral angiogram, (G) right VA injection and (H) left common carotid artery injection showing no residual dAVF.
Tables
- Table 1
Classification of dAVFs: Borden versus Cognard
Natural course Borden classification Cognard classification Type Venous drainage site CVR Type Venous drainage site Flow pattern in sinus CVR Benign I Dural sinus No I Dural sinus Antegrade No Benign IIa Dural sinus Retrograde No Aggressive II Dural sinus Yes IIb Dural sinus Antegrade Yes Aggressive IIa+b Dural sinus Retrograde Yes Aggressive III Cortical vein Yes III Cortical vein Yes without venous ectasia Aggressive IV Cortical vein Yes with venous ectasia Aggressive V Cortical vein with spinal medullary drainage Yes CVR, cortical venous reflux; dAVF, dural arteriovenous fistula.
