• Abdulrahman Y Alturki, Alejandro Enriquez-Marulanda, Philip Schmalz, Christopher S Ogilvy, and Ajith J Thomas.
• Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
• World Neurosurg. 2018 Jan 1; 109: 398-402.

BackgroundCurrently, the mainstay treatment of dural arteriovenous fistula (DAVF) involves endovascular approaches, especially for high-grade lesions. Transarterial embolization with preservation of venous sinuses has become the preferred approach due to the development of newer liquid embolic agents. For further precision during embolization, the use of temporary balloon occlusion to protect the patency of dural sinuses from the embolic agent's migration has been described.MethodsA 64-year-old man presented with bilateral pulsatile tinnitus and visual decline. A diagnostic cerebral angiogram demonstrated a complex bilateral Borden type II and Cognard type IIB DAVF. Treatment was carried out endovascularly under general anesthesia in a staged fashion. In the first stage, the balloon was inflated during embolization to protect the right transverse sigmoid venous sinus system and torcula. In the second stage, the balloon was again inflated to protect the left transverse sigmoid venous sinus system and torcula during embolization. Complete obliteration of the left DAVF was achieved, and patency of the left transverse and sigmoid sinuses was preserved. Patency of the right transverse and sigmoid sinus was also conserved post procedure.ResultsThe patient was treated successfully with transarterial Onyx embolization with transvenous balloon protection of the sinus.ConclusionsThis case is the first reported use of the Copernic RC balloon in the United States under the compassionate use guidelines of the U.S. Food and Drug Administration. The use of this balloon is becoming a useful treatment alternative in selected cases of DAVFs as it improves the safety and efficacy of transarterial embolization as evidenced in this case.Copyright © 2017 Elsevier Inc. All rights reserved.

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