Parasagittal and Superior Sagittal Sinus Dural Arteriovenous Fistulas: Clinical Presentations, Imaging Characteristics, and Treatment Strategies
Bibliographic record
Abstract
BACKGROUND AND PURPOSE: Parasagittal and superior sagittal sinus (SSS) dural arteriovenous fistulas (DAVFs) are often inappropriately classified. We explore the clinical presentations, imaging characteristics, and endovascular treatment strategies of these 2 DAVF subtypes. MATERIALS AND METHODS: Clinical and imaging data of 19 patients with SSS or parasagittal sinus DAVFs who underwent endovascular treatment in our institution between 2017 and 2022 were retrospectively analyzed. The angiographic findings, endovascular treatment strategies, and angiographic outcomes were evaluated and recorded. RESULTS: Among these 19 patients, 14 had a parasagittal DAVF, 4 had a SSS DAVF, and 1 patient had both parasagittal and SSS DAVF. Only 1 (1/19, 5.26%) patient presented with intracranial hemorrhage. For the parasagittal DAVF group, most of the shunts were located along the middle third of the SSS (12/15, 80%), on the dura in proximity with the junctional zone between the bridging vein and SSS (15/15, 100%), with ipsilateral cortical venous reflux (CVR) (15/15, 100%). For the SSS DAVF group, all 5 patients had shunting zone along the middle third of the SSS, on the sinus or parasinus wall, with bilateral CVR. Transarterial embolization, via the middle meningeal artery as the primary route of access, was the primary treatment approach in 95% of cases (19/20). Reflux of embolization material into the SSS was observed in 1 case (1/5, 20%) of SSS DAVF in which balloon sinus protection was not used during embolization. CONCLUSIONS: Our study found that parasagittal DAVFs have shunting point(s) centered on the junctional zone of the bridging vein and the SSS with ipsilateral CVR, while SSS DAVFs have shunting point(s) centered on the sinus or parasinus wall with bilateral CVR. Transarterial embolization via the middle meningeal artery can be used as the primary treatment strategy in most cases. Balloon sinus protection during embolization is not necessary in cases of parasagittal DAVF with occluded or stenosed connection with the SSS but its use should be considered in cases of SSS DAVF with patent sinus.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".