Embolization of an intracranial dural arteriovenous fistula using ultrasound-guided puncture of a pericranial venous pouch.

Endovascular treatment of intracranial dural arteriovenous fistulas can be very challenging. Conventional endovascular treatment approaches include transarterial or transvenous access from the common femoral artery or vein, respectively. A novel approach is described for endovascular treatment of an aggressive type 4 dural arteriovenous fistula. This patient, who had recently suffered an associated intracranial hemorrhage, harbored a dural arteriovenous fistula involving his transverse dural venous sinus that did not allow for conventional transarterial or transvenous embolization routes. The clinical history and technical details are provided.