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Transarterial Coil Embolization of the Venous Component of Aggressive Type 4 Dural Arteriovenous Fistulas

K.F. Laytona, M.D. Nelsona and D.F. Kallmesa

a From the Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minn


Figure 1
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  		Fig 1. A, Right common carotid artery injection demonstrates massively enlarged inferolateral and meningohypophyseal trunks feeding a tentorial dural arteriovenous fistula (dAVF). This dAVF is also supplied by multiple external carotid artery (ECA) feeding vessels, including the petrous branch of the middle meningeal artery and the posterior division of the middle meningeal artery. The collecting pouch in the region of the tentorium drains into multiple cortical veins toward the midline to the deep venous fistula. Multiple cortical veins drain this fistula. The eventual emptying site is along the transverse sinus.

B, Right external carotid angiography demonstrates the course of the middle meningeal artery with supply to the fistula by the posterior division.

C, Right common carotid angiography demonstrates the microcatheter coursing through the posterior division of the middle meningeal artery with the tip in the venous pouch.

D, Right common carotid artery (CCA) injection after coil-embolization demonstrates no further fistula flow. Note course of microguidewire in the middle meningeal artery.


Figure 2
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  		Fig 2. A, Right external carotid angiography demonstrates supply to the fistula via an enlarged posterior division of the middle meningeal artery.

B, Lateral digital subtraction angiogram (DSA) of left external carotid artery shows venous outlet of dural arteriovenous fistula in the region of the vein of Galen. Proximal collecting pouch is cephalad to the vein of Galen. A venous varix is present downstream from the proximal collecting pouch.

C, Lateral DSA with microcatheter placed via the right middle meningeal artery into the proximal collecting pouch.

D, Final control DSA showing coil position and occlusion of the fistula.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X