ABSTRACT
An unusual case of dural arteriovenous malformation (DAVM) harboring a parallel transverse-sigmoid sinus (TSS) is presented. The patient had a 2-year history of left-sided pulsatile tinnitus in the left ear refractory to medical management. Angiography demonstrated a DAVM involving the left TSS. Super-selective transvenous dural sinus occlusion of the DAVM situated at the pathological compartment of the TSS provided cure. We were able to spare the normal compartment providing anatomical venous drainage from this system.
Subject(s)
Central Nervous System Vascular Malformations/pathology , Cerebrovascular Circulation/physiology , Cranial Fossa, Posterior/abnormalities , Cranial Sinuses/abnormalities , Cranial Sinuses/pathology , Brain/blood supply , Central Nervous System Vascular Malformations/diagnostic imaging , Central Nervous System Vascular Malformations/therapy , Cerebral Angiography , Clinical Protocols , Cranial Fossa, Posterior/blood supply , Cranial Sinuses/diagnostic imaging , Diagnosis, Differential , Embolization, Therapeutic/methods , Female , Humans , Middle Aged , Prostheses and Implants , Prosthesis Implantation/methods , Tinnitus/etiology , Treatment OutcomeABSTRACT
OBJECTIVE: To describe a variant of the stent-assisted coiling technique in the endovascular treatment of aneurysms with a dome-to-neck ratio less than 1.5. CLINICAL PRESENTATION: This technique, named the stentjack technique, consisted of the deployment of a first coil before the delivery of a self-expandable stent across the aneurysm neck without detachment. Once the stent was deployed, the first coil was detached. TECHNIQUE: This maneuver enabled us to constrain the coil loops within the sac before detachment of the first coil, a coil that is often critical when dealing with broad-neck aneurysms. We successfully treated three patients harboring wide-neck aneurysms. CONCLUSION: We found that the stentjack technique was helpful in the treatment of selective aneurysms with a dome-to-neck ratio smaller than 1.5.
