Occipital Sinus Dural Arteriovenous Fistula Presenting with Cerebellar Hemorrhage.
BACKGROUND
Occipital sinus (OS) dural arteriovenous fistula (DAVF) is extremely rare, and we are aware of no case accompanied by cerebral hemorrhage. We present a case of OS DAVF presenting with cerebellar hemorrhage, treated successfully by transvenous embolization.


CASE DESCRIPTION
A 62-year-old female presented with headache and nausea of recent onset. Computed tomography revealed left cerebellar hemorrhage with perihematomal edema. Angiography showed OS DAVF fed by bilateral occipital and posterior meningeal arteries, with drainage into the left inferior hemispheric vein and right transverse sinus receiving the shunt flow from OS. The caudal side of the OS was occluded. The inferior hemispheric vein was dilated with 2 varices, and the junction between the OS and right transverse sinus was narrowed. Because the OS was not involved in normal cerebellar drainage, transvenous embolization of the OS was performed. The microcatheter was advanced to the OS from the transverse sinus during balloon occlusion at the confluence of sinuses. Coils were placed in the OS from the caudal to cranial side, and complete occlusion of the shunt was obtained.


CONCLUSIONS
This is the first report of OS DAVF presenting with cerebellar hemorrhage. Transvenous embolization of the affected OS appears ideal when transvenous access is feasible, and the OS is not involved in normal venous drainage of the cerebellum.
['Kawauchi|Takeshi|T|', 'Ikeda|Hiroyuki|H|', 'Miyakoshi|Akinori|A|', 'Go|Koichi|K|', 'Oichi|Yuki|Y|', 'Sano|Noritaka|N|', 'Hayase|Makoto|M|', 'Toda|Hiroki|H|']
D020785:Central Nervous System Vascular Malformations D002526:Cerebellar Diseases D002533:Cerebral Angiography D003392:Cranial Sinuses D004621:Embolization, Therapeutic D005260:Female D006801:Humans D020300:Intracranial Hemorrhages D008576:Meningeal Arteries D008875:Middle Aged
Occipital sinus Dural arteriovenous fistula Cerebellar hemorrhage