Transverse-sigmoid sinus dural arteriovenous fistulae are abnormal arteriovenous communications within the dural wall of the transverse-sigmoid sinuses. They present with a variety of clinical features, ranging from benign bruits to intracranial hemorrhage and neurologic deficits. The presentation and natural history of these fistulae are largely determined by the pattern of venous drainage. Knowledge of natural history and careful study of the angioarchitecture by angiography is therefore mandatory for correct management of these lesions. In this review, anatomy and pathology, principles of management, and the various factors that influence treatment decisions are discussed, with a focus on endovascular therapy. Indications for endovascular treatment, therapeutic goals, approaches, and techniques are reviewed. The role of surgical treatment is also briefly discussed.
