Transcranial Direct Middle Meningeal Artery Puncture for the Onyx Embolization of Dural Arteriovenous Fistula Involving the Superior Sagittal Sinus.
10.3340/jkns.2015.57.1.54
- Author:
Jae Sang OH
1
;
Seok Mann YOON
;
Jai Joon SHIM
;
Hack Gun BAE
Author Information
1. Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea. smyoon@schmc.ac.kr
- Publication Type:Case Report
- Keywords:
Dural arteriovenous fistula;
Superior sagittal sinus;
Transcranial;
Middle meningeal artery;
Onyx embolization
- MeSH:
Aged;
Arteries;
Central Nervous System Vascular Malformations*;
Cerebral Angiography;
Diamond;
Female;
Fistula;
Humans;
Meningeal Arteries*;
Paraparesis;
Punctures*;
Seizures;
Skull;
Superior Sagittal Sinus*;
Temporal Arteries
- From:Journal of Korean Neurosurgical Society
2015;57(1):54-57
- CountryRepublic of Korea
- Language:English
-
Abstract:
A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.
