A transverse sinus dural arteriovenous fistula (DAVF) not easily accessible by standard transfemoral (transarterial or transvenous) endovascular approaches is presented. An enlarged transosseous retromastoid foramen harboring the occipital artery branch feeding the lesion was identified on CT angiogram (CTA). Curative Onyx embolization was achieved via percutaneous CT-guided direct puncture of the transosseous occipital arterial branch followed by microcatheter navigation through the needle distally towards the site of the fistula.
AlatakisSKoulourisGStuckeyS. CT-demonstrated transcalvarial channels diagnostic of dural arteriovenous fistula. Am J Neuroradiol2005; 26: 2393–2396.
2.
NarvidJDoHMBlevinsNH. CT angiography as a screening tool for dural arteriovenous fistula in patients with pulsatile tinnitus: Feasibility and test characteristics. Am J Neuroradiol2011; 32: 446–453.
3.
RivetDJGoddardJK3rdRichKM. Percutaneous transvenous embolization of a dural arteriovenous fistula through a mastoid emissary vein. Technical note. J Neurosurg2006; 105: 636–639.
4.
SauraPSauraJPerez-HiguerasA. Direct transforaminal Onyx embolization of intracranial dural arteriovenous fistulas: Technical note and report of five cases. J Neurointerv Surg2014; 6: 500–504.
5.
ChapotRSaint-MauriceJPNarataAP. Transcranial puncture through the parietal and mastoid foramina for the treatment of dural fistulas. Report of four cases. J Neurosurg2007; 106: 912–915.
