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High grade torcular DAVF: Technical aspects to safely sacrifice the straight sinus
James Lord1, Mohammad Al-Tibi1, David Volders1
1Division of Neuroradiology, University Medical Imaging Toronto and Joint Department of Medical Imaging, University Health Network, Toronto Western Hospital, Canada.
The Neuroradiology Journal
|August 5, 2025
Summary
High-grade torcular dural arteriovenous fistulas (DAVFs) with retrograde flow pose treatment challenges. This study details safe endovascular techniques for straight sinus sacrifice in complex DAVF cases.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- High-grade torcular dural arteriovenous fistulas (DAVFs) present significant therapeutic difficulties.
- Retrograde flow in the straight sinus and deep venous system complicates management strategies.
Purpose of the Study:
- To describe the technical methodology for the safe endovascular sacrifice of the straight sinus.
- To provide guidance for managing complex torcular DAVFs with challenging venous anatomy.
Main Methods:
- Preoperative magnetic resonance imaging (MRI) for detailed anatomical assessment.
- Comprehensive arterial and venous cerebral blood flow evaluation.
- Step-by-step description of endovascular techniques for straight sinus sacrifice.
Main Results:
- Successful demonstration of technical steps for safe straight sinus sacrifice.
- Identification of key considerations for endovascular treatment in complex DAVF scenarios.
Conclusions:
- Endovascular straight sinus sacrifice is a feasible technique for select high-grade torcular DAVFs.
- Careful preoperative planning and intraprocedural assessment are crucial for successful outcomes.
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