Targeted Transvenous Embolization Under Sinus Balloon Protection for Transverse-Sigmoid Sinus Dural Arteriovenous Fistula: A Technical Note

Dural arteriovenous fistulas (DAVFs) at the transverse-sigmoid sinus (TSS) are often treated with transarterial embolization (TAE) or sinus occlusion. Although sinus balloon protection has become increasingly utilized in TAE to preserve sinus patency, its application in transvenous embolization (TVE) has rarely been reported. In a case involving a Borden type Ⅰ/Cognard IIa TSS DAVF with localized parasinus shunting, three-dimensional rotational angiography clearly delineated the detailed structure of the shunted pouch, allowing precise transvenous access. TVE was successfully performed using coils and Onyx under sinus balloon protection, resulting in complete occlusion of DAVF while maintaining sinus patency. Targeted TVE under sinus balloon protection may offer a viable, sinus-preserving alternative to conventional TAE or sinus occlusion in select cases of TSS DAVFs with parasinus shunt concentrations.