Prstojević Branko, Mićović Mirko, Vukasinović Ivan, Nagulić Mirjana
Clinical Center of Serbia, Center for Radiology and Magnetic Resonance, Belgrade, Serbia.
Vojnosanit Pregl. 2011 Dec;68(12):1079-83.
Dural carotid cavernous fistula is acquired, relatively rare, condition comprising of numerous small-caliber meningeal arterial branches, draining directly into cavernous sinus. Endovascular therapy is the treatment of choice, preferably by a transvenous approach. In the case of inaccessible inferior petrosal sinus, other alternative routes are considered. We presented a case of dural carotid cavernous fistula completely occluded with Guglielmi detachable coils, using a transvenous approach through facial and superior ophthalmic vein.
A 62-year-old man was referred with a gradual worsening proptosis, red eye, and decreased visual acuity, on the right side. Digital subtraction an giography revealed the presence of a right dural carotid cavernous fistula, predominantly supplied from dural branches of the right internal carotid artery siphon, with minimal contribution from the right middle meningeal artery and contra lateral dural branches of the left internal carotid artery siphon. The fistula was drainaged through the dilated superior ophthalmic vein, and via the facial to the internal jugular vein. There was neither pacification of pterygoid and petrous sinuses, nor cortical venous reflux. Endovascular treatment was performed by a transvenous approach. A guiding catheter was placed in the right facial vein. A microcatheter was advanced through the dilated angular and superior ophthalmic vein, and its tip positioned into the right cavernous sinus. Coils were deployed, until a complete angiographic occlusion of the fistula had been achieved. The patient experienced rapid improvement in the symptoms, with complete normalization of his condition one month after the treatment.
Coil embolization of dural carotid cavernous fistula by transvenous catheterization, through the facial and superior ophthalmic vein, can be considered as safe and effective treatment option in the presence of marked anterior drainage.
硬脑膜海绵窦瘘是一种后天性、相对罕见的疾病，由众多小口径脑膜动脉分支组成，直接引流至海绵窦。血管内治疗是首选治疗方法，最好采用经静脉途径。在岩下窦难以到达的情况下，可考虑其他替代途径。我们报告了一例硬脑膜海绵窦瘘患者，通过经面部和眼上静脉的经静脉途径，使用 Guglielmi 可脱性弹簧圈完全闭塞了瘘口。
一名 62 岁男性因右侧眼球突出逐渐加重、眼红和视力下降前来就诊。数字减影血管造影显示右侧存在硬脑膜海绵窦瘘，主要由右侧颈内动脉虹吸部的脑膜分支供血，右侧脑膜中动脉和左侧颈内动脉虹吸部的对侧脑膜分支供血较少。瘘口通过扩张的眼上静脉引流，并经面部引流至颈内静脉。翼腭窦和岩窦均未显影，也无皮质静脉回流。采用经静脉途径进行血管内治疗。将引导导管置于右侧面部静脉。微导管经扩张的内眦静脉和眼上静脉推进，其尖端置于右侧海绵窦内。释放弹簧圈，直至瘘口在血管造影上完全闭塞。患者症状迅速改善，治疗后 1 个月病情完全恢复正常。
在存在明显前向引流的情况下，经面部和眼上静脉经静脉导管置入弹簧圈栓塞硬脑膜海绵窦瘘可被视为一种安全有效的治疗选择。
