Surgical Burr Hole Access for Direct Sinus Puncture and Transvenous Coil Embolization of a Complex Superior Sagittal Sinus Dural Arteriovenous Fistula

Abstract

Dural arteriovenous fistulas (dAVFs) account for 10–15% of all cerebral vascular malformations,1 and their location around the superior sagittal sinus is rare with an incidence of 4–11% of all dAVFs.2 Endovascular transarterial or transvenous embolization are the treatment routes of choice for dAVFs,3 but in rare cases direct sinus access may be favorable.4 5 We present an unusual case of a complex superior sagittal sinus dAVF with multiple arterial feeders and an occluded posterior superior sagittal sinus segment which was challenging for classic embolization routes. A combined surgical and endovascular approach in the hybrid biplane operating room was performed and is shown in video 1. By using a direct surgical burr hole for sinus access anterior to the dAVF and the thrombosed sinus portion followed by transvenous coil embolization, the dAVF was cured in a minimally invasive and safe fashion.Video 1Treatment of a complex superior sagittal sinus dural arteriovenous fistula by surgical burr hole access for direct sinus puncture and transvenous coil embolization.