Dural arteriovenous fistula of the transverse-sigmoid sinus with intraventricular hemorrhage: a case report

We report a case of dural arteriovenous fistula of the transverse-sigmoid sinus (TS-DAVF) with intraventricular hemorrhage. An 83-year-old woman presented with headache and vomiting. Neurological examination showed no defects. CT scans demonstrated intraventricular hemorrhage. Left external carotid angiograms showed a dural arteriovenous fistula of the isolated transverse-sigmoid sinus fed by the occipital and middle meningeal arteries. The draining vein was the leptomeningeal vein. Left internal carotid angiograms demonstrated venous congestion in the left temporal and occipital lobes. This case was grade 4 according to Lalwani's classification. I-123-IMP SPECT revealed a low perfusion area in the left temporal and occipital regions. Dynamic CT scans revealed venous congestion in the left temporal and occipital regions. We considered that the venous congestion was the cause of intraventricular hemorrhage. Initially, we embolized the DAVF using a transarterial approach with liquid material. However, the embolization of the DAVF was not complete. Therefore, we treated the DAVF by sinus packing with coils using a small craniotomy. Angiographic cure was obtained and the postoperative course was uneventful. We discuss the clinical features, the hemodynamic findings and the management of this case.