Parallel Dural Sinus Dural AV Fistula : Diagnosis and Treatment

1. Parallel Dural Sinus Dural AV Fistula: Diagnosis and Treatment Hon-Man Liu, MD,MBA National Taiwan University Hospital Taipei, Taiwan Conflict of interest: none

2. 42M, pulsated tinnitus

3. 34 F, vascular tinnitus, insomnia, headache

5. Supplying arteries • Other sinus DAVF Sinus wall Sinus wall Sinus wall Sinus wall • Parallel sinus DAVF Supplying arteries Fistula site

6. Parallel dural sinus DAVF • Fistulae site is inside the dural wall. They form venous channels inside the wall, which may run parallel to the sinus. • It can drain to the sinus or adjacent cortical veins. • The adjacent sinus may be patent or partial occluded. • It can occur in different location. It can be associated with other type of DAVF such as osseous type or dural sinus type.

7. National Taiwan University Hospital 2008.04-2010.04 Average age: 53.2y (SD=12.8y)

8. Associated with sinus thrombosis N=3

9. Treatment of parallel dural sinus DAVF • Identify the exact location of the fistulae site • The sinus or important normal drainage approximate to the lesion should be preserved • Sometimes combination with other methods • Stuffing or packing between the 2 layers of duramater with coils

10. DAVF occurs at duralsinus to which is proximate or inside the skull bones. Therefore, it is difficult to demonstrate the detail vascular pattern and to make diagnosis of DAVF on conventional CTA, even more for parallel sinus DAVF Original CTA Pre-contrast CT Post-contrast CT Hybrid CTA Radiology 2010 Jul;256(1):219-28. Subtraction CTA MMBE CTA

11. 56 F, pulsated tinnitus, recent onset seizure

12. 56 F, pulsated tinnitus, recent onset seizure

13. 42M, pulsated tinnitus

14. Fistula site Via occluded sigmoid sinus Save the vein of Labbe 34 F, vascular tinnitus, insomnia, headache

16. Outcome good in 9 Outcome Stable in 3

17. Conclusion • Parallel sinus DAVF is not rare • Precise diagnosis is important • Mis-diagnosis might cause disaster such as occluding the normal sinus