Management Strategies for Intracranial Dural Arteriovenous Fistulas with an Isolated Sinus: A 20-Year Single-Center Experience.

Authors

James Lord, Joao A Sousa, Uri Singfer, Ronette Goodluck Tyndall, Patrick Nicholson, Robert Willinsky, Vitor M Pereira, Hugo Andrade, Pascal J Mosimann, Ivan Radovanovic, Karel Ter Brugge, David Volders, Timo Krings, Eef J Hendriks

Published in

AJNR. American journal of neuroradiology. Oct 09, 2026. Epub Oct 09, 2026.

Abstract

Isolated sinus dural arteriovenous fistulas (DAVFs) are rare, aggressive subtypes of arteriovenous shunt. Optimal treatment strategies remain poorly defined.
To present a 20-year single-center experience evaluating treatment strategies and outcomes for isolated sinus DAVFs.
We retrospectively analyzed all adult patients treated for isolated sinus DAVFs at our institution from January 2004 to March 2025. Isolated sinus DAVFs were defined as fistulas draining into venous sinus segments that are functionally isolated, i.e. have no antegrade or retrograde venous sinus outflow. Data included clinical presentation, angiographic features, treatment approach, outcomes, and complications.
Of 425 patients treated for intracranial DAVFs, 35/425 (8%) had an isolated sinus DAVF and underwent 43 treatment sessions. Transarterial embolization (TAE) was the initial treatment in 23/35 (66%) patients, achieving immediate single-session angiographic occlusion in 17/23 (74%) and final single-session occlusion in 18/23 (78%) after spontaneous thrombosis of a residual fistula in one case. Transvenous embolization (TVE) was the initial treatment in 10/35 (29%) patients, achieving immediate single-session angiographic occlusion in 8/10 (80%) and final single-session occlusion in 9/10 (90%) after spontaneous thrombosis in one case. Three open burr-hole-assisted TVE procedures - one primary and two salvage - achieved complete occlusion. Two open surgical disconnections, one primary and one salvage, also achieved complete occlusion. Five patients (5/35; 14%) required more than one treatment session. Three major complications occurred across 43 treatment sessions (3/43; 7%). No residual fistula was identified in any patient at last available imaging follow-up.
Isolated sinus DAVFs are challenging to manage and may require multimodal treatment. Our findings support individualized, angioarchitecture-based treatment selection for this complex DAVF subtype.

PMID:
42855272
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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