Volume 59 No 1  Cover Story

Transcranial transarterial Onyx embolization of superior sagittal sinus (SSS) dural arteriovenous fistula (dAVF) in a 66-year-old woman. Right external carotid artery (ECA) angiography showed dAVF on SSS fed by both middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries (OAs) and drained into the SSS which was occluded in the posterior one third. Marked retrograde bilateral superficial cortical venous reflux was also demonstrated (first low, left and middle). Final ECA lateral angiograms of transarterial Onyx embolization through MMA and STA still showed the partial obliteration of dAVF after first session (first low, right). After one week, on second session, roadmap image shows the drilling point of MMA for transcranial transMMA approach (second low, left). Photograph shows the placement of 4 Fr sheath in the MMA and fixation with black silk tie to prevent accidental removal during the procedures (second low, middle). Microcatheter angiogram shows the dAVFs clearly (second low, right). Postoperative ECA anterioposterior angiograms showing the complete obliteration of dAVFs without cortical venous reflux (third low, left). Postoperative skull anterioposterior and lateral radiographs shows the Onyx cast after complete obliteration of dAVFs (third low, middle and right).