Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment

Transvenous approach. Arteriography of a petrosal dAVF with petrosal outflow, fed by the recurrent tentorial branch of the infero-lateral trunk and a posterior meningeal branch, draining into the internal temporal vein. Retrograde catheterization of the straight sinus via the jugular golf and lateral sinus. Two Echelon 10 microcatheters (Covidien) were navigated to the foot vein located on the internal temporal vein. By means of 1 microcatheter, platinum coils were rolled; then Onyx 18 was injected through the second microcatheter. The dAVF was totally cured at the end of the intervention. A, Lateral initial angiogram. B, Transvenous coiling. C, Transvenous Onyx injection. D, Cast of Onyx and coils.

Transarterial approach. Arteriography of a ruptured dAVF with a shunt located in the declival vein and venous outflow into the cerebellar veins, fed by the PMA of the vertebral artery, transosseous branches of the occipital artery and squamous branch of the MMA. The MMA was catheterized; platinum coils were rolled into the MMA to improve NAEL penetration, and then, NAEL was injected. A, Lateral initial angiogram via the external carotid artery. B, Lateral initial angiogram via the vertebral artery. C, Coils with the pressure cooker technique in the MMA. D, Final cast of Onyx and coils.

Double balloons with a pressure cooker technique. Arteriography of an unruptured petrosal dAVF, fed by the medial tentorial branch of the MHT and a tentorial branch of the MMA, draining into superior petrosal vein with an outflow into the perimedullary veins. A balloon pressure cooker technique was used. A Scepter XC 4 × 11 balloon (MicroVention, Tustin, California) was inflated in the MMA to improve the Onyx injection, while protecting the carotid siphon with a Copernic balloon (Balt Extrusion, Montmorency, France). While both balloons were inflated, Onyx 18 was injected in a single session using a Marathon microcatheter (Covidien). Total occlusion of the shunt was noted on the final angiography. A, Antero-posterior initial angiogram. B, Lateral initial angiogram. C, Balloon pressure cooker technique in the MMA with the balloon-protecting device in the ICA. D, Final cast of Onyx.