Direct Burr Hole Access for Transverse-Sigmoid Junction DAVF Embolization: A Case Report

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Radiology

Background:

• Dural arteriovenous fistulas (DAVFs) are uncommon intracranial vascular malformations.
• Intracranial hemorrhage is a significant complication of DAVFs.
• Treatment typically involves embolization, but anatomical challenges can arise.

Observation:

• A 72-year-old male presented with headache and pulsatile tinnitus, diagnosed with Borden II/Cognard IIa+b DAVF.
• Initial transarterial embolization reduced shunting by 30%.
• Conventional transvenous embolization was unsuccessful due to complex sinus anatomy and occlusion.

Findings:

• A minimally invasive approach using a single burr hole and neuronavigation enabled direct access to the DAVF.
• Embolization of the left transverse-sigmoid sinus junction with coils successfully occluded the fistula.
• Post-procedure angiography confirmed complete cure with no residual shunting.

Implications:

• Minimally invasive surgery offers a viable alternative for DAVFs when standard embolization techniques are not feasible.
• This case underscores the importance of tailored, multi-disciplinary strategies for complex vascular malformations.
• Neuronavigation-guided direct access provides a potentially safer and effective treatment option for challenging DAVF cases.