{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T05:26:00Z","timestamp":1771651560840,"version":"3.50.1"},"reference-count":14,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T00:00:00Z","timestamp":1685145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography revealed a Borden II\/Cognard IIa+b DAVF. He underwent stage 1 transarterial embolization of the occipital artery which reduced shunting by 30%. Several attempts were made to access the fistula during stage 2 transvenous embolization, but it was not possible to access the left transverse sinus fistula site since there was no communication across the torcula from the right transverse sinus and the left inferior sigmoid\u2013jugular bulb was occluded. Therefore, a single burr hole was drilled and direct access to the DAVF was achieved with a micropuncture needle under neuronavigational guidance. The left transverse\u2013sigmoid sinus junction was then embolized with coils. After the procedure, angiography revealed that the DAVF was cured with no residual shunting. This case demonstrates how minimally invasive surgery provides an alternative method to access a DVAF when conventional transarterial and\/or transvenous embolization treatment options are not possible. Each DAVF case has unique anatomy and physiology, and creative multi-disciplinary strategies can often yield the best results.<\/jats:p>","DOI":"10.3390\/brainsci13060871","type":"journal-article","created":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T16:19:37Z","timestamp":1685204377000},"page":"871","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Direct Burr Hole Access for Transverse\u2013Sigmoid Junction DAVF Embolization: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1913-3578","authenticated-orcid":false,"given":"James","family":"Withers","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine, University of New England, Biddeford, ME 04005, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-3484","authenticated-orcid":false,"given":"Robert","family":"Regenhardt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-5699","authenticated-orcid":false,"given":"Adam","family":"Dmytriw","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Vranic","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rudolph","family":"Marciano","sequence":"additional","affiliation":[{"name":"Northern Light Neurosurgery and Spine, Bangor, ME 04401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Stapleton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aman","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.nec.2011.09.004","article-title":"Selection of treatment modalities or observation of dural arteriovenous fistulas","volume":"23","author":"Paul","year":"2012","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1227\/01.neu.0000317311.69697.fc","article-title":"Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae","volume":"62","author":"Singh","year":"2008","journal-title":"Neurosurgery"},{"key":"ref_3","first-page":"147","article-title":"Clinical characteristics of dural arteriovenous fistula","volume":"9","author":"Kim","year":"2002","journal-title":"J. Clin. Neurosci. Off. J. Neurosurg. Soc. Australas."},{"key":"ref_4","first-page":"804","article-title":"Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?","volume":"7","author":"Negro","year":"2021","journal-title":"Tomogr. Ann. 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Neurosci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"276","DOI":"10.3340\/jkns.2015.58.3.276","article-title":"Tentorial Dural Arteriovenous Fistula Treated Using Transarterial Onyx Embolization","volume":"58","author":"Kim","year":"2015","journal-title":"J. Korean Neurosurg. 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