Article Figures & Data
Figures
- Fig 1.
Schematic of normal dural arteriovenous architecture (A), with arrows pointing to the arterial arcade in the wall of the transverse/sigmoid sinuses. Schematic of dural fistula angioarchitecture according to a view of multiple arteriovenous shunts (black arrows) draining either separately via multiple discrete veins into the sinus (B) or into a common venous collector/pouch/septation (C) alongside the wall of the sinus proper. D, A low-grade dural fistula according to the common arterial collector view. Multiple arterial feeders converge on a common arterial channel in the sinus wall that empties into the sinus at a single fistulous point (arrowhead). E, Common arterial collector schematic relative to normal anatomy shown in A. The arterial supply converges on the common collector arterial channel within the sinus wall (arrow), with the fistulous point (arrowhead) at the confluence of this channel and the sinus proper.
- Fig 2.
Schematic of typical transvenous sinus sacrifice (A) and incomplete (B) and complete (C) transarterial embolizations, each of which results in an unnecessary closure of arteries or sinus. Targeted occlusion of the shunt (D) at the entrance of the collector channel into the sinus preserves both the sinus and normal arterial structures.
- Fig 3.
A, Left sigmoid sinus type I dural fistula. Posterior meningeal supply (B) proceeds via arteries in the wall of the transverse/sigmoid sinuses (arrows). Subselective external carotid artery injection (C) shows robust occipital and middle meningeal artery supply. D, Inflation of a compliant balloon within the sigmoid sinus reduces transfistulous flow to allow identification of a common collector channel (white arrow) inferior to the sinus proper. E and F, Transvenous microcatheterization of a common collector channel (E, distal catheter tip) and subsequent fistulogram (F) reduce the fistula to a single point where the collector joins the sinus (white arrow). Subselective coiling of this collector (G) results in fistula closure (H and I).
- Fig 4.
A and B, Left type I sigmoid sinus fistula with predominant occipital and middle meningeal supply. C, A 5F VERT (Cook, Bloomington, Indiana) catheter (tip marked by a black arrow) in the sigmoid sinus is wedged into the opening of the common collector (white arrow). Gentle injection of the VERT catheter identifies a second opening of the collector into the sinus shown by the black arrowhead. D, A stronger injection of the VERT (fistulogram) opacifies the entire arterial arcade in a retrograde fashion. E, Scepter C (MicroVention Tustin, California) subselective catheterization of the common collector, with a subsequent n-BCA cast in F. G and H, Postembolization angiography demonstrates occlusion of the fistula with preservation of the left sigmoid sinus.
- Fig 5.
Additional examples of a common collector channel. Case 1 (A–C) of a type IIa fistula shows the collector channel inferior to the sinus (C, white arrow) during Onyx (Covidien, Irvine, California) injection via a Scepter C microcatheter (MicroVention). Case 2 (D–F) illustrates a relatively uncommon presence of a common collector superior to the sinus (white arrows), becoming more obvious after the sinus has been packed with coils. Case 3 (G–I) is another complex-appearing fistula, where the common collector channel (white arrows) is better seen via the left vertebral contributors (H) due to stenosis of the sinus proper. The collector channel is subsequently filled with coils (I, white arrows). In retrospect, cases 2 and 3 might have been cured by superselective embolization rather than sinus sacrifice.
Tables
Breakdown by Cognard type, hemorrhage status on presentation, and presence of a common collector channel
Cognard Type No. Hemorrhagic Presentation (No.) Common Channel (No.) (%) 1 15 0 14 (93%) IIa 12 0 5 (42%) IIb 0 0 NA IIab 3 0 1 (33%) III 6 4 2 (33%) Note:—NA indicates not applicable.
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