Transvenous embolisation of dural arteriovenous fistulae with coils

In 32 of 69 patients with a durai fistula at the cavernous sinus, transvenous embolisation was used when glaucoma and loss of vision could not be controlled by transarterial embolisation, or in 16 where there was cortical drainage of the fistula. Exact closure of the fistulous points in the cavernous sinus was performed using platinum microcoils. These resulted in primary or secondary clinical and radioanatomical cure as documented by follow-up angiography in all but 4 patients, who had persistent symptoms, or their ocular signs recurred. No additional cortical drainage developed. In a second operation, the cavernous sinus and the origin of the ophthalmic vein were occluded totally with coils. In 16 fistulae at the transverse/sigmoid sinus, transvenous coil embolisation was used when cortical drainage or a intolerable bruit persisted after arterial embolisation. A definitive occlusion was achieved in all but one case, as documented by angiography 3 months later. There were no major complications, but all the patients complained of headache, and/ or vomiting and vertigo within the first 2–3 weeks.