Transvenous coil embolization of a Cognard V transverse-sigmoid sinus dural arteriovenous fistula

Dural arteriovenous fistulas with drainage into the spinal veins, classified as Cognard type 5, can be challenging to diagnose and treat. Brainstem and cervical spinal cord signal abnormalities onmagnetic resonance imaging result from venous congestion, and canmimic tumor, infection, or inflammation.(1-3) Transarterial and transvenous embolization techniques can be used to treat dural arteriovenous fistulas endovascularly. Efficacious transvenous treatment relies on the ability to safely catheterize the draining vein at the dural arterio-venous fistula site. Transvenous access options may seem limited in the setting of occluded venous sinuses. This case highlights the technical aspects of the transvenous approach to embolization of a transverse-sigmoid sinus dural arteriovenous fistula within an isolated sinus,(4,5) demonstrating traversal of the occluded venous sinus from a contralateral approach.6,7