PMC4896129_01
68-year-old man with a dural arteriovenous fistula of the superior sagittal sinus. Axial T2-weighted image demonstrates old right thalamic hemorrhage with hemosiderin within (large white arrow). Large vessel medially (black arrow) is a venous varix. Several flow voids are seen in enlarged scalp arteries. (Small arrows).
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MRI of the brain (Figure 1A, Figure 1B, Figure 1C) disclosed sequelae of previous hemorrhages with hemosiderin deposition in the right thalamus and several enlarged deep veins with a venous varix adjacent to the old thalamic hemorrhage.
68-year-old man with a dural arteriovenous fistula of the superior sagittal sinus. Axial T2-weighted image shows abnormally increased signal in the pons.
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Catheter angiogram demonstrated a complex superior sagittal sinus dural arteriovenous fistula with extensive arterial supply from branches of the external carotid arteries bilaterally, extracranial muscular branches of the left vertebral artery and pial branches of the left anterior and middle cerebral arteries (Figure 2A, Figure 2B, Figure 2D, Figure 2E, Figure 2F, Figure 2G). The injection was stopped for 30-120 seconds when any of the three danger signs was seen: 1) penetration of Onyx into the sinus 2) when there was any reflux around the catheter tip or 3) if there was retrograde filling into another feeder, particularly if filling of a pial branch was seen (Figure 2c).
68-year-old man with a dural arteriovenous fistula of the superior sagittal sinus. Axial T2-weighted image shows several enlarged cortical veins.
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After two sessions of embolization, the first day to treat the right side and the second day to treat the left side, the fistula was obliterated with no residual filling (Figure 3A, Figure 3C). As well, there was no evidence of residual fistula on follow-up catheter angiogram of bilateral external carotid arteries (ECA), internal carotid artery (ICA) and vertebral arteries (Figure 3).