Selective Bridging Vein Embolization of a Transverse-Sigmoid Sinus Dural Arteriovenous Fistula Draining via the...

Bridging veins adjacent to the jugular foramen (JF-BVs) are rare drainage pathways in dural arteriovenous fistulas (DAVFs). We report a unique case of a transverse-sigmoid sinus DAVF (TS-DAVF) with retrograde venous drainage via a JF-BV, successfully treated with selective transvenous coil embolization.

A man in his 60s presented with a 2-month history of right-sided pulsatile tinnitus. Cerebral angiography revealed a high-grade TS-DAVF supplied by branches of the external carotid and vertebral arteries. Venous drainage involved a compartmentalized portion of the sigmoid sinus that drained into a JF-BV, continuing through the retrotonsillar and inferior vermian veins to the confluence of sinuses. Additional reflux occurred via the ipsilateral and contralateral TSs, the superior petrosal sinus, and cortical veins through the vein of Labbé. The right internal jugular vein was occluded at the cervical level. A transvenous approach via the contralateral jugular vein allowed catheter navigation via a compartmentalized portion of the jugular bulb separated by trabecular septations to reach the JF-BV. After superselective angiography confirmed its course, coil embolization was performed from the lateral medullary vein junction back to the sinus. Shunt flow was completely occluded while preserving normal cortical venous drainage. The patient's tinnitus resolved without neurological deficits.

To the best of our knowledge, this is the first reported case of selective transvenous coil embolization of a JF-BV draining a TS-DAVF. Preprocedural imaging with selective angiography and a multi-catheter system enabled safe and effective treatment. Selective JF-BV embolization may represent a viable therapeutic option for DAVFs with catheter-navigable compartments.