Direct Transverse Sinus Cannulation for Coil Embolization of a Transverse-Sigmoid Sinus Dural Arteriovenous Fistula: 2-Dimensional Operative Video

A 65-yr-old male presented 2 mo after an episode of acuteonset headache associated with altered mental status. Imaging workup with cerebral angiography revealed a Cognard type IV right-sided transverse-sigmoid junction dural arteriovenous fistula (dAVF). The patient was treated with endovascular embolization of several pedicles from the middle meningeal (MMA) and occipital arteries. Residual filling and cortical venous reflux were noted on follow-up imaging. Therefore, definitive treatment of the persistent fistula was offered with a combined open and endovascular embolization approach.(1) This would provide direct access into the sinus followed by embolization of the fistula. In the accompanying video, we present the case in detail and provide a discussion of the rational and treatment nuances associated with this approach. Patient consent was given prior to the procedure and consent and approval for this operative videowerewaived due to the retrospective nature of thismanuscript and the anonymized video material.