In-out-in technique for petrosal sinus dural arteriovenous fistula obliteration: How I Do It

BackgroundDural arteriovenous fistulas (dAVFs) at the superior petrosal sinus are a rare but important subtype that pose a high risk of mortality and morbidity. Treatment for these lesions can be challenging with stand-alone endovascular methods.MethodsWe describe our "in-out-in" technique for disconnecting dAVFs at the superior petrosal sinus, which includes definitive sacrifice of the superior petrosal sinus and the transverse sigmoid sinus, if involved. This method achieves complete fistula obliteration and minimizes recurrence risk with new arterial feeders.ConclusionsThe in-out-in technique is a safe and effective approach for the treatment of dAVFs involving the superior petrosal sinus.