Dural arteriovenous fistula may be occluded through recanalization of impaired venous sinuses

To investigate the effect and safety of recanalization of stenosed or occluded venous sinuses for dural arteriovenous fistulas (DAVFs) and possible mechanism of DAVF formation, patients with DAVF accompanied by venous sinus stenosis or occlusion treated with balloon angioplasty and/or stenting were retrospectively enrolled. The clinical data, treatment outcomes and complications were analyzed. In 7 patients enrolled, the DAVF was Cognard IIa grade in 3 (42.9% or 3/7) and IIa + b in 4 (57.1% or 4/7) patients, including complex DAVFs in 2 (28.6% or 2/7). The angioplasty procedure was successful in all (100%) patients, including complete cure in 3 (42.9% or 3/7) patients with the initial Cognard grade IIa, transformation from Cognard grade IIa + b to I in 2 (28.6% or 2/7) patients, and unchanged Cognard grade IIa + b in 2 (28.6% or 2/7) patients. The symptoms were all improved. At 3-month angiographic follow-up, 5 (71.4% or 5/7) cases were cured, whereas 2 cases still had grade I fistulas but no clinical symptoms. Staged embolization in 2 patients resulted in significant symptom improvement. At the last follow-up of a median 4 years, no clinical symptoms were present in 5 (71.4% or 5/7) patients, intermittent headache in 1 (14.3% or 1/7), and death from trauma in 1 (14.3% or 1/7). In conclusion, endovascular recanalization of occluded or stenosed venous sinuses using balloon angioplasty and stenting is able to induce occlusion of DAVFs and is a safe and efficient treatment approach for DAVFs which are possibly caused by significant pressure increase.