Object: Transvenous embolization is an effective treatment for dural arterio-venous fistulas. In the event of dural sinus thrombosis, embolization can be performed by direct puncture via craniectomy. We report our experience with transcranial venous embolization in two patients.
Methods: Two patients underwent transcranial venous embolization of a type-III dural arterio-venous fistula of the transverse sinus. The craniectomy was performed with neuronavigation assistance.
Results: The surgical approach consisted in a minimal exposure of the sinus with a drill. Neuronavigation allowed accurate placement of the craniectomy. The endovascular treatment was performed in a second stage, enabling complete and stable occlusion of the fistula in both patients.
Conclusion: This combined treatment of dural AVFs associating craniectomy and transcranial puncture of the sinus is simple and efficient when retrograde navigation through the internal jugular vein cannot be achieved. Neuronavigation is helpful in accurately positioning the craniectomy.