Transfistulous coil occlusion of high-grade tentorial dural arteriovenous fistulas: An effective alternative to liquid embolic agents

Endovascular therapy (EVT) of dural arteriovenous fistulas (DAVF) includes transarterial and transvenous techniques, or EVT combined with surgery. The transfistulous approach (TFA) allows occlusion of the proximal venous outflow via transarterial catheterization through the AV shunt. We report five cases of tentorial DAVF treated using this technique, with complete anatomical occlusion in 4 patients, and near-complete occlusion in one. Clinical cure was achieved in 4 patients; one patient with advanced dementia showed no change in symptoms. No complications were observed. The TFA is safe and highly effective, especially in managing high-grade DAVFs, and represents a valuable alternative to traditional EVT techniques.