Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, 137-701, South Korea.
Neuroradiology. 2012 Feb;54(2):163-9. doi: 10.1007/s00234-011-0852-4. Epub 2011 Mar 3.
Dural arteriovenous fistulas involving marginal sinus are relatively rare. Transvenous embolization is a curative treatment of choice for them. Regional anatomy surrounding the marginal sinus comprises complex craniocervical bony structures and abundant venous interconnections. Therefore, dural arteriovenous fistulas involving marginal sinus may have various routes for a transvenous approach. The purpose of this article was to analyze endovascular treatment of marginal sinus dural arteriovenous fistulas with emphasis on the routes of transvenous embolization.
Five patients with dural arteriovenous fistulas (DAVFs) involving the marginal sinus who were treated with transvenous embolization were retrospectively analyzed in terms of endovascular treatment: angiographic architecture, routes of venous approach, and treatment results case by case.
There were no significant complications except for headache, ocular pain, and facial flushing after transvenous embolization. Immediate angiographic outcomes were complete in four patients and partial in one patient. Clinical outcomes during follow-up were complete recovery in four patients and intermittent tinnitus in one patient. Three different transvenous approaches were used for transvenous coil embolization: ipsilateral internal jugular vein in three patients, contralateral internal jugular vein in one patient, and vertebral venous plexus in one patient.
Transvenous coil embolization in treating marginal sinus DAVF is a safe and effective method. In case of failure of an internal jugular venous approach, alternative routes of embolization should be considered. Understanding the regional venous anatomy of the craniocervical junction is important for targeting fistulous sites and selecting routes for transvenous embolization.
涉及边缘窦的硬脑膜动静脉瘘相对少见。经静脉栓塞是其首选的治疗方法。边缘窦周围的区域解剖包括复杂的颅颈骨结构和丰富的静脉连接。因此，涉及边缘窦的硬脑膜动静脉瘘可能有多种经静脉入路的途径。本文旨在分析经静脉栓塞治疗边缘窦硬脑膜动静脉瘘，重点分析经静脉栓塞的入路途径。
回顾性分析 5 例经静脉栓塞治疗的边缘窦硬脑膜动静脉瘘患者的血管内治疗情况：血管造影结构、静脉入路途径和逐个病例的治疗结果。
除经静脉栓塞后出现头痛、眼部疼痛和面部潮红外，无明显并发症。4 例患者即刻血管造影结果完全，1 例患者部分缓解。4 例患者随访时临床结果完全恢复，1 例患者间歇性耳鸣。3 例患者采用了 3 种不同的经静脉入路进行经静脉线圈栓塞：3 例患者采用同侧颈内静脉，1 例患者采用对侧颈内静脉，1 例患者采用椎静脉丛。
经静脉线圈栓塞治疗边缘窦硬脑膜动静脉瘘是一种安全有效的方法。如果颈内静脉入路失败，应考虑替代栓塞途径。了解颅颈交界处的区域性静脉解剖对于确定瘘口部位和选择经静脉栓塞入路非常重要。
