Dural arteriovenous fistula (DAVF) often occurs in the cavernous sinus, transverse sinus, sigmoid sinus, tentorium, etc. A DAVF in the falcine sinus is extremely rare in adults. DAVF treatment has progressed from microsurgery to endovascular treatment (EVT). At present, the treatment for DAVF in the falcine sinus is mainly EVT.
We present 2 cases of DAVF in the falcine sinus. In case 1, the patient was a 38-year-old male, and in case 2, the patient was a 35-year-old female; both had sudden onset of cerebral hemorrhage. They underwent CT angiography (CTA) and/or digital subtraction angiography (DSA), which showed a DAVF in the falcine sinus. In case 1, the feeding artery was only the right middle meningeal artery (MMA), which drained to the superior sagittal sinus through the cortical vein. In contrast, in case 2, there were a variety of feeding arteries, including bilateral ophthalmic arteries, the internal maxillary artery and the right MMA, and the DAVF drained through both cortical veins and cerebral deep veins simultaneously. Both were cases of Cognard type IV DAVF. Using Onyx (Medtronic, Irvine, California, USA), both patients underwent complete EVT through the MMA, with a satisfactory therapeutic outcome.
We believe that it is highly feasible to use Onyx for DAVFs in the falcine sinus using an arterial approach through the MMA to perform EVT. Nevertheless, due to the limited number of cases, we still need to accumulate additional experience.
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