Pipeline embolization device as a standalone curative approach for recurrent sigmoid sinus DAVF.
Vera Sharashidze, Charlotte Chung, Peter Kim Nelson et al.
✦ AI-curated · Sources linked
Case in brief
A 74-year-old man developed a recurrent sigmoid sinus dural arteriovenous fistula after meningioma resection. The fistula recurred with worsening symptoms despite transvenous and middle meningeal artery embolization. Sinus sacrifice and transarterial embolization were unsuitable because the dominant right sigmoid sinus was important for cerebral venous drainage. A reconstructive approach using a Pipeline embolization device construct occluded the fistula while preserving sinus function. Follow-up angiography showed stable occlusion and normalized intracranial venous drainage.
What made this case unusual
Flow diversion was used to treat the recurrent fistula while preserving a dominant sigmoid sinus whose role in venous drainage made conventional options unsuitable.
Diagnostic / clinical pearl
When a dAVF involves a sinus essential to cerebral venous drainage, assess whether a reconstructive strategy can occlude the fistula while maintaining sinus function.