Imaging Characteristics of Dural Arteriovenous Fistulas with Occlusive Stenosis Transverse-Sigmoid Sinus on Digital Subtraction Angiography

Abstract

Background: Dural arteriovenous fistulas account for about 10% of intracranial vascular malformations. In particular, fistulas related to the transverse sinus and sigmoid sinus have the second frequency of
occurrence, only after the cavernous sinus in Vietnam. The pathogenesis of dural fistula at this location is often related to chronic venous sinus stenosis. The purpose of our study is to evaluate the imaging characteristics of transverse- sigmoid sinus dural arteriovenous fistulas (TSS-DAVFs) as well as classifying lesions and sinus stenosis to stratify risk.
Methods: Cross-sectional study of case series with TSS-DAVFs who underwent DSA performed at Cho Ray Hospital from 1/2018 to 1/2024.

Results: In 47 patients with TSS-DAVFs who underwent DSA: average age was 53 years old, female/male ratio was 2.1/1, lateral fistula was found in 40/7 cases, bilateral fistula was found in 7/47 cases, feeder artery is popular the meningeal branch of the external carotid artery, classified as Cognard IIa 23.4%, Cognard IIb 17.1%, Cognard IIa+IIb 31.8%, Cognard III 12.7%% and Cognard IV 15.0%. Regarding stenosis TSS, the chronic complete occlusion of lateral TSS accounts for the majority with 55.3%, TSS stenosis 19.1%, and stenosis bilateral TSS 25.5%.
Conclusion: Dural arteriovenous fistula with transverse-sigmoid sinus stenosis on subtraction angiography shows mostly unilateral fistulas, the main feeding artery is the middle meningeal artery branch and is often associated with venous hypertension and cortical venous reflux.