1.
Piippo A, Niemelä M, van Popta J, Kangasniemi M, Rinne J, Jääskeläinen JE, Hernesniemi J. Characteristics
and long-term outcome of 251 patients with dural arteriovenous fistulas in a defined population. J Neurosurg.
2013;118:923-34.
2.
van Dijk JM, terBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas
with long-term persistent cortical venous reflux. Stroke. 2002;33:1233-6.
3.
Cho WS, Han JH, Kang HS, Kim JE, Kwon OK, Oh CW, Han MH, Chung YS. Treatment outcomes of
intracranial dural arteriovenous fistulas of the transverse and sigmoid sinuses from a single institute in Asia. J
Clin Neurosci. 2013;20:1007-12.
4.
Carlson AP, Alaraj A, Amin-Hanjani S, Charbel FT, Aletich V. Endovascular approach and technique for
treatment of transverse-sigmoid dural arteriovenous fistula with cortical reflux: the importance of venous sinus
sacrifice. J Neurointerv Surg. 2013;5:566-72.
5.
Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous
malformations and implications for treatment. J Neurosurg. 1995;82:166-79.
6.
Miller TR, Gandhi D. Intracranial Dural Arteriovenous Fistulae: Clinical Presentation and Management
Strategies. Stroke. 2015;46:2017-25.
7.
Bhatia KD, Lee H, Kortman H, Klostranec J, Guest W, Wälchli T, Radovanovic I, Krings T, Pereira VM.
Endovascular Management of Intracranial Dural AVFs: Transvenous Approach. AJNR Am J Neuroradiol.
2022;43:510-16.
8.
Komiyama M, Ishiguro T, Matsusaka Y, Yasui T, Nishio A. Transfemoral, transvenous embolisation of dural
arteriovenous fistula involving the isolated transverse-sigmoid sinus from the contralateral side. Acta
Neurochir (Wien). 2002;144:1041-6.
9.
Kiyosue H, Tanoue S, Okahara M, Hori Y, Kashiwagi J, Sagara Y, Kubo T, Mori H. Angioarchitecture of
transverse-sigmoid sinus dural arteriovenous fistulas: evaluation of shunted pouches by multiplanar
reformatted images of rotational angiography. AJNR Am J Neuroradiol. 2013;34:1612-20.
12
10. Abecassis IJ, Meyer RM, Levitt MR, Sheehan JP, Chen CJ, Gross BA, Smith J, Fox WC, Giordan E, Lanzino
G, Starke RM, Sur S, Potgieser ARE, van Dijk JMC, Durnford A, Bulters D, Satomi J, Tada Y, Kwasnicki A,
Amin-Hanjani S, Alaraj A, Samaniego EA, Hayakawa M, Derdeyn CP, Winkler E, Abla A, Lai PMR, Du R,
Guniganti R, Kansagra AP, Zipfel GJ, Kim LJ. Recurrence after cure in cranial dural arteriovenous fistulas: a
collaborative effort by the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR). J
Neurosurg. 2021;10:1-9.
11. Guédon A, Saint-Maurice JP, Thépenier C, Labeyrie MA, Civelli V, Sissy CE, Eliezer M, Aymard A,
Guichard JP, Houdart E. Results of transvenous embolization of intracranial dural arteriovenous fistula: a
consecutive series of 136 patients with 142 fistulas. J Neurosurg. 2021;28:1-9.
12. Halbach VV, Higashida RT, Hieshima GB, Goto K, Norman D, Newton TH. Dural fistulas involving the
transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology. 1987;163:443-7.
13. Halbach VV, Higashida RT, Hieshima GB, Mehringer CM, Hardin CW. Transvenous embolization of dural
fistulas involving the transverse and sigmoid sinuses. AJNR Am J Neuroradiol. 1989;10:385-92.
14. Sadeh-Gonike U, Magand N, Armoiry X, Riva R, Labeyrie PE, Lamy B, Lukaszewicz AC, Lehot JJ, Turjman
F, Gory B. Transarterial Onyx Embolization of Intracranial Dural Fistulas: A Prospective Cohort, Systematic
Review, and Meta-Analysis. Neurosurgery. 2018;82:854-63.
15. Ambekar S, Gaynor BG, Peterson EC, Elhammady MS. Long-term angiographic results of endovascularly
"cured" intracranial dural arteriovenous fistulas. J Neurosurg. 2016;124:1123-7.
16. Tanoue S, Kiyosue H, Hori Y, Abe T, Mori H. Turn-back embolization technique for effective transvenous
embolization of dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2012;33:E88-91.
17. Matsuda W, Sonomura T, Honma S, Ohno S, Goto T, Hirai S, Itoh M, Honda Y, Fujieda H, Udagawa J,
Takano S, Fujiyama F, Ueda S. Anatomical variations of the torcular Herophili: macroscopic study and clinical
aspects. Anat Sci Int. 2018;93:464-68.
13
18. Alexander MD, Oliff MC, Olorunsola OG, Brus-Ramer M, Nickoloff EL, Meyers PM. Patient radiation
exposure during diagnostic and therapeutic interventional neuroradiology procedures. J Neurointerv Surg.
2010;2:6-10.
19. Kohta M, Fujita A, Tanaka J, Sasayama T, Hosoda K, Kohmura E. Novel Segmentation of Placed Coils in the
Treatment of Cavernous Sinus Dural Arteriovenous Fistulas Provides a Reliable Predictor of the Long-Term
Outcome in Abducens Nerve Palsy. World Neurosurg. 2018;113:e38-e44.
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Figure captions
Fig. 1 Flow diagram highlighting the selection for multimodal treatments for patients with transverse-sigmoid sinus
dural arteriovenous fistula (TSS DAVF). TAE transarterial embolization, TVE transvenous embolization
Fig. 2 (a) Lateral view of right common carotid angiography shows a Borden type III transverse–sigmoid sinus dural
arteriovenous fistula (TSS DAVF). (b) A superior view of three-dimensional computed tomography angiography
reconstruction shows a right TSS DAVF associated with retrograde cortical reflux. The right transverse sinus groove
(white arrows) is clearly seen without opacification of the sinus. Intraprocedural anterior–posterior (c) and lateral (d)
fluoroscopic views show coils within the transverse sinus, which were placed via the contralateral approach. (e) A
lateral view of right common carotid angiography obtained at the end of the procedure shows complete occlusion of
the DAVF.
Fig. 3 (a) Lateral view of left common carotid angiography shows a complex Borden type III transverse–sigmoid
sinus dural arteriovenous fistula (TSS DAVF). (b) Left oblique view of three-dimensional rotational angiography
(3D-RA) shows the shunting point is located at the sigmoid–jugular junction (white arrow); spiral parallel channels
(arrow heads) are shown connecting to the transverse–sigmoid junction. (c) Another 3D-RA view shows a shunting
point at the transverse–sigmoid junction fed by the middle meningeal artery. TVE was performed via the
contralateral approach. Anterior–posterior (d) and lateral (e) fluoroscopic views during the procedure show coils in
the sigmoid–jugular junction. Final coil configuration is shown in other anterior–posterior (f) and lateral (g) views.
h) Lateral view of left common carotid angiography performed at the end of the procedure shows complete
occlusion of the DAVF.
Fig. 4 Boxplots of differences in the mean sinus pressures (MSPs) in the initial measurement (a) and maximum
measurement during procedure (b) according to two approaches. Sinus pressure gradient (SPG) (c) were calculated
15
as the differences of initial and maximum pressure measurements in the sinus. Initial and maximum MSPs and SPG
were significantly higher in the ipsilateral approach group (P <0.05). The boxplots follow Tukey’s convention: the
maximum whiskers are 1.55 × interquartile range and outliers are marked with circles.
iTVE, transvenous embolization via the ipsilateral approach; cTVE, transvenous embolization via the contralateral
approach
16
Table 1 Baseline characteristics of the study patients (n = 18)
Characteristics
Age (IQR) - yr
65 (56-72)
Male sex - no. (%)
8 (44.4)
Clinical presentations - no. (%)
Intracranial hemorrhage
9 (50.0)
Seizure
5 (27.8)
Headache
8 (44.4)
Dementia
3 (16.7)
Pulsatile tinnitus
3 (16.7)
Incidental
1 (2.2)
Feeding arteries - no. (%)
Middle meningeal artery
18 (100)
Ascending pharyngeal artery
14 (77.8)
Transosseous branch of OA
18 (100)
Tentorial branch of ICA
14 (77.8)
Posterior menigeal artery
4 (22.2)
Fistulous portions - no. (%)
Sigmoid-jugular junction
4 (22.2)
Horizontal portion of SS
8 (44.4)
Transverse-sigmoid junction
14 (77.8)
Junction of vein of Labbé
8 (44.4)
Distal portion of TS
4 (22.2)
Varix of drainage vein - no. (%)
Vein of Labbé
2 (11.1)
Petrosal vein
1 (5.6)
Temporal vein
1 (5.6)
Follow up period (IQR) -months
57 (30-77)
Values are presented as the median with interquartile range (IQR) for
continuous variables and counts (percentage) for categorical variables
TVE transvenous embolization, OA occipital artery, ICA internal
carotid artery, SS sigmoid sinus, TS transverse sinus
Table 2 Comparison of treatment results between ipsi- and contralateral TVE approaches
Ipsilateral TVE
Contralateral TVE
(n = 8)
(n = 10)
P -value
Multiple sessions - no. (%)
1 (10)
1.000
Additional TAE - no. (%)
1 (13)
2 (20)
1.000
TS groove on reconstructed CT - no. (%)
7 (70)
0.004*
Opacified sinuses - no. (%)
Simoid-jugular junction
2 (20)
0.477
Horizontal portion of SS
5 (63)
6 (60)
1.000
Transverse-sigmoid junction
5 (63)
8 (80)
0.451
Junction of vein of Labbé
7 (88)
10 (100)
0.512
Distal portion of TS
1 (13)
3 (30)
0.567
Sinus pressure (IQR) - mmHg
Initial MSPs
43.5 (35.5-48.0)
29.5 (24.0-37.3)
0.033*
Maximum MSPs
69.0 (59.5-77.0)
40.5 (35.8-44.3)
0.011*
SPG
22.5 (17.5-29.5)
5.5 (2.0-18.7)
0.021*
MAP of the arm (IQR), mmHg
91 (79-97)
90 (85-96)
0.929
Operation time (IQR) - min
340 (322-420)
367 (315-442)
0.789
Fluoroscopic time (IQR) - min
155 (131-188)
161 (146-181)
0.824
SAD (IQR) - mGy
3300(2815-3895)
2887 (2850-3937)
0.824
Complications - no. (%)
Cranial nerve palsy
Hemorrhage
1(13)
1.000
Initial angiographical results - no. (%)
Complete occlusion
8 (100)
9 (90)
1.000
Near-complete occlusion
1 (10)
1.000
Incomplete occlusion
Follow up radiological results - no. (%)
Complete occlusion
8 (100)
10 (100)
1.000
Near-complete occlusion
Incomplete occlusion
Recurence - no. (%)
1 (10)
1.000
Clinical outcome - no. (%)
No change
7 (88)
8 (100)
1.000
Improvement
1 (13)
2 (20)
1.000
Deteriorate or new symptoms
Values are presented as the median with interquartile range (IQR) for continuous variables and counts
(percentage) for categorical variables
TAE transarterial embolization, TVE transvenous embolization, TS transverse sinus, CT conputed comography
scan, SS sigmoid sinus, IQR interquartile range, MSPs mean sinus pressures, SPG sinus pressure gradient,
...
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