Clinico-pathological study in patients with transverse-sigmoid sinus dural arteriovenous malformations

Treatment modalities and histopathological findings of transverse-sigmoid sinus dural arteriovenous malformations (AVMs) were evaluated. Twenty-eight patients with this disease were treated with a variety of treatment modalities. Ten patients were treated surgically. Of these patients, 3 were treated with sinus isolation, 4 with sinus removal and 3 with palliative operation. Ten patients underwent endovascular surgery. Of these patients, 3 were treated with transarterial embolization (TAE) alone, 2 with transvenous embolization (TVE) alone and 5 with direct sinus packing (DSP) with/without TAE and/or TVE. Eight patients were treated conservatively. The resected dural sinuses were cut into serial sections and evaluated histopathologically. The histopathological study revealed the communications between dural arteries and dural veins emptying the involved sinus. No direct communication between dural arteries and the sinus lumen was found. The essential lesion of the dural AVMs was confirmed to be the dural AV fistulas within the sinus wall. Transvenous or direct sinus packing may well offer a radical and safer alternative to the surgical treatment, but still requires a long-term follow-up.