Hiu Takeshi, Horie Nobutaka, Hayashi Kentaro, Kitagawa Naoki, Morikawa Minoru, Kawakubo Junichi, Tsutsumi Keisuke, Suyama Kazuhiko, Nagata Izumi
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8501, Japan.
Radiat Med. 2008 Aug;26(7):431-7. doi: 10.1007/s11604-008-0245-8. Epub 2008 Sep 4.
We present a unique case of a cavernous sinus (CS) dural arteriovenous fistula (DAVF), which recurred at adjacent sinuses following repeated transvenous embolizations (TVEs). A 68-year-old woman presented with progressive left conjunctival chemosis and diplopia. Cerebral angiography revealed a left CS DAVF, which was completely obliterated by TVE via the left inferior petrosal sinus (IPS). Two years later, the DAVF recurred in the left IPS, and again in the left sigmoid sinus (SS) 3 years after the initial treatment in spite of a second TVE. Moreover, the left SS and the left internal jugular vein, which had been previously stenotic, had been occluded. The third TVE resulted in the complete obliteration of the SS DAVF. CS DAVFs may recur at adjacent sinuses even after complete obliteration by TVE. Careful follow-up is necessary to check for the recurrence of DAVFs, especially in cases with venous flow changes, such as sinus occlusion, following endovascular treatment.
我们报告了一例独特的海绵窦（CS）硬脑膜动静脉瘘（DAVF）病例，该病例在多次经静脉栓塞术（TVE）后于相邻窦复发。一名68岁女性出现进行性左侧结膜水肿和复视。脑血管造影显示左侧CS DAVF，通过经左侧岩下窦（IPS）进行TVE将其完全闭塞。两年后，DAVF在左侧IPS复发，并且在初始治疗3年后尽管进行了第二次TVE，但又在左侧乙状窦（SS）复发。此外，先前已狭窄的左侧SS和左侧颈内静脉已闭塞。第三次TVE导致SS DAVF完全闭塞。即使经TVE完全闭塞后，CS DAVF仍可能在相邻窦复发。有必要进行仔细随访以检查DAVF的复发情况，尤其是在血管内治疗后出现静脉血流改变（如窦闭塞）的病例中。
