A Case of Transverse Sinus Dural Arteriovenous Fistula Treated by Transvenous Embolization via the Mastoid Emissary Vein with Femoral Venous Approach

Objective: To describe a case of dural arteriovenous fistulas (DAVFs) involving the isolated transverse sinus (TS) treated by transvenous embolization (TVE) via the mastoid emissary vein (MEV) with the femoral venous approach.Case Presentation: An 86-year-old woman presented with cerebral hemorrhage. Angiography showed DAVFs involving the left isolated TS with retrograde cortical venous drainage. Transvenous approach through the occluded sigmoid sinus into the affected sinus failed; however, we could easily advance a microcatheter into the isolated sinus via the MEV. The DAVFs were completely occluded by selective TVE combined with transarterial embolization, and reconstruction of antegrade cerebral venous drainage from the vein of Labbe’ to the MEV was obtained.Conclusion: The MEV can be an alternative approach route for TVE of transverse-sigmoid sinus DAVFs when an approach through the occluded sinus is difficult or failed.