Direct surgical removal of the dural arteriovenous fistulas involving transverse-sigmoid sinuses

We investigated the operative methods and the angiographical classification in eight patients with dural arteriovenous fistulas involving transverse-sigmoid sinuses. There were two men and six women with a mean age of 68.3 (range 61-73) years. The initial symptoms were focal neurological deficits (aphasia, hemiparesis, hemianopsia) because of intracranial haematoma in four patients, dementia in two, headache in one and pulsatile tinnitus in one. Preoperatively, transarterial coil embolisaton was performed in four patients and transvenous coil embolisation in three. Finally total removal was performed in all patients. In all patients angiogram showed the presence of sinus occlusion diagnosed in the late venous phase and retrograde flow from the sinuses to the cortical veins. According to Borden's classification, three patients were classified as Type II-C (or C'), four patients as Type III-D and one patient as Type E. The volume of blood loss did not change either with or without preoperative transarterial coil embolisation. There was no new procedure-related morbidity. The presence of sinus occlusion diagnosed in the late venous phase and retrograde flow from the sinuses to the cortical veins indicate that total removal is possible.