{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T14:46:38Z","timestamp":1781534798445,"version":"3.54.5"},"reference-count":15,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nOnyx has already been reported as an effective and safe agent in transarterial embolization of cranial dural arteriovenous fistula (d-AVF). However, successful treatment is related to not only complete shunt obliteration but also preservation of a normal route of venous drainage. Here, we present a case of transverse sigmoid d-AVF in which successful treatment was achieved by transarterial Onyx embolization with targeted balloon protection of the venous drainage.<\/jats:p>\n<\/jats:sec>\n\nCase Description: <\/jats:title>\nA 70-year-old man presented with a 3-month history of tinnitus in the left ear and mild headache. Magnetic resonance imaging (MRI) showed a cluster of abnormal blood vessels in the area of the left transverse sinus (TS)-sigmoid sinus (SS) junction. Cerebral angiography demonstrated a Cognard type IIa d-AVF at the left TS-SS junction, supplied mainly by vessels such as the left middle meningeal artery, left occipital artery, and left meningohypophyseal trunk. In the venous phase, the ipsilateral TS-SS was recognized as a functional sinus and the left vein of Labbe drained into the TS near the drainage channel. Based on these findings, we decided to perform endovascular treatment under a transarterial approach with Onyx using targeted balloon protection of the venous sinus to protect against Onyx migration and preserve antegrade sinus flow. The patient recovered well without sequelae, and follow-up MRI 12 months later showed complete disappearance of the d-AVF.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nThis treatment strategy using targeted balloon protection may be very useful to preserve antegrade sinus flow in patients with Cognard type IIa d-AVF.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_503_2021","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T11:04:56Z","timestamp":1626087896000},"page":"340","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Utility of targeted balloon protection of the venous sinus for endovascular treatment of dural arteriovenous fistula by transarterial embolization with Onyx: A case report and literature review"],"prefix":"10.25259","volume":"12","author":[{"given":"Masahiko","family":"Tagawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Murayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirabe","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saya","family":"Ozaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Nishikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Shigekawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeharu","family":"Kunieda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"10.25259\/SNI_503_2021\/ref-1","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1586\/17434440.3.6.705","article-title":"Onyx: A unique neuroembolic agent","volume":"3","author":"Ayad","year":"2006","journal-title":"Expert Rev Med Devices"},{"key":"10.25259\/SNI_503_2021\/ref-2","doi-asserted-by":"crossref","first-page":"e179","DOI":"10.5114\/pjr.2019.84602","article-title":"Are Type I dural arteriovenous fistulas safe? Single-centre experience of endovascular treatment of dural arteriovenous fistulas","volume":"84","author":"Brzozowski","year":"2019","journal-title":"Pol J Radiol"},{"key":"10.25259\/SNI_503_2021\/ref-3","doi-asserted-by":"crossref","first-page":"E994","DOI":"10.1227\/01.NEU.0000351772.45417.92","article-title":"Reconstructive treatment using a stent graft for a dural arteriovenous fistula of the transverse sinus in the case of hypoplasia of the contralateral venous sinuses: Technical case report","volume":"65","author":"Choi","year":"2009","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_503_2021\/ref-4","doi-asserted-by":"crossref","first-page":"235","DOI":"10.3174\/ajnr.A0817","article-title":"Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: New management using Onyx","volume":"29","author":"Cognard","year":"2008","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_503_2021\/ref-5","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1177\/159101999700300405","article-title":"The natural history and management of intracranial dural arteriovenous fistulae. Part. 2: Aggressive lesions","volume":"3","author":"Davies","year":"1997","journal-title":"Interv Neuroradiol"},{"key":"10.25259\/SNI_503_2021\/ref-6","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.3171\/2016.5.JNS16331","article-title":"Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas","volume":"126","author":"Gross","year":"2017","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_503_2021\/ref-7","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00234-012-1107-8","article-title":"Transvenous balloon assisted transarterial Onyx embolization of transverse-sigmoid dural arteriovenous malformation","volume":"55","author":"Jittapiromsak","year":"2013","journal-title":"Neuroradiology"},{"key":"10.25259\/SNI_503_2021\/ref-8","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.radcr.2020.01.018","article-title":"Transarterial Onyx 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