Unusual Presentation of a Dural Arteriovenous Fistula of the Superior Sagittal Sinus and Single Modality Therapy with Onyx

Brian W. Chong, Bart M Demaerschalk

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Abstract

Superior sagittal sinus (SSS) dural arteriovenous fistulas (DAVF) are rare and present unique challenges to treatment. Complex, often bilateral, arterial supply and involvement of large volumes of eloquent cortical venous drainage may necessitate multimodality therapy. We report a case of a DAVF of the SSS in a patient who presented uniquely with increasing dizziness and disequilibrium who was treated with a single modality, endovascular embolization with ethyl vinyl alcohol co-polymer (Onyx, EV3, Irvine, CA). The patient underwent staged embolization in 2 sessions with no complications. An angiographic cure was achieved and the patient's symptoms were ameliorated. Single modality therapy with endovascular embolization of a SSS DAVF can be achieved. Careful attention to technique during embolization with Onyx is required, but complete obliteration is possible without the need for adjunctive surgical resection.

Original languageEnglish (US)
Article number158
JournalRadiology Case Reports
Volume3
Issue number1
DOIs
StatePublished - 2008

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Superior Sagittal Sinus
Central Nervous System Vascular Malformations
Dizziness
Drainage
Polymers
Ethanol
Therapeutics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

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abstract = "Superior sagittal sinus (SSS) dural arteriovenous fistulas (DAVF) are rare and present unique challenges to treatment. Complex, often bilateral, arterial supply and involvement of large volumes of eloquent cortical venous drainage may necessitate multimodality therapy. We report a case of a DAVF of the SSS in a patient who presented uniquely with increasing dizziness and disequilibrium who was treated with a single modality, endovascular embolization with ethyl vinyl alcohol co-polymer (Onyx, EV3, Irvine, CA). The patient underwent staged embolization in 2 sessions with no complications. An angiographic cure was achieved and the patient's symptoms were ameliorated. Single modality therapy with endovascular embolization of a SSS DAVF can be achieved. Careful attention to technique during embolization with Onyx is required, but complete obliteration is possible without the need for adjunctive surgical resection.",
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