Hsu Yu-Hone, Lee Chung-Wei, Liu Hon-Man, Wang Yao-Hung, Chen Ya-Fang
Department of Neurosurgery, Cheng-Hsin General Hospital; Taipei, Taiwan -
Department of Medical Imaging, National Taiwan University Hospital; Taipei, Taiwan.
Interv Neuroradiol. 2014 May-Jun;20(3):368-77. doi: 10.15274/INR-2014-10028. Epub 2014 Jun 17.
We report our experience in treating the anterior condylar dural arteriovenous fistula (DAVF) and confirm the location of the coils in the follow-up images after successful endovascular treatment. We retrospectively reviewed the 14 patients with anterior condylar DAVF treated successfully in our institute. Twelve of them had CT or MR follow-up images. All the patients had intravascular coiling of the fistula. Seven of our patients had retrograde drainage to different sinuses. Three had ocular symptoms as a clinical manifestation. We treated nine patients with coils alone (eight transvenous, one transarterial), four with adjuvant transarterial treatment with particles or liquid embolic for minimal residual after coiling packing. One patient had failed onyx treatment and successful treatment by following transvenous packing. All patients had total obliteration of the DAVF fistula on immediate post-procedure angiogram or on the follow-up images and no evidence of recurrence clinically. The mean follow-up period was 34.2 months (standard deviation=39.8). Twelve patients had computed images (CT alone in four, MR alone in five, both CT and MR in three). These findings were analyzed by four certified neuroradiologists. We found 100% of the coils at the anterior condylar veins inside the hypoglossal canal, 54.2% at the lateral lower clivus, and only 14.2% at the anterior condylar confluence which is ventrolateral to the anterior orifice of the hypoglossal canal. Intravascular coiling is the treatment of choice in patients with anterior condylar DAVF. All the coils were found at the anterior condylar veins inside the hypoglossal canal after successful treatment.
我们报告了治疗髁前硬脑膜动静脉瘘（DAVF）的经验，并在成功的血管内治疗后的随访图像中确认了弹簧圈的位置。我们回顾性分析了我院成功治疗的14例髁前DAVF患者。其中12例有CT或MR随访图像。所有患者均接受了瘘口的血管内弹簧圈栓塞治疗。7例患者有向不同窦的逆行引流。3例有眼部症状作为临床表现。我们对9例患者仅采用弹簧圈治疗（8例经静脉，1例经动脉），4例在弹簧圈栓塞后用颗粒或液体栓塞剂辅助经动脉治疗以减少残留。1例患者Onyx治疗失败，随后经静脉栓塞成功。所有患者在术后即刻血管造影或随访图像上DAVF瘘口均完全闭塞，临床上无复发迹象。平均随访期为34.2个月（标准差=39.8）。12例患者有计算机图像（4例仅有CT，5例仅有MR，3例既有CT又有MR）。这些结果由4名认证神经放射科医生进行分析。我们发现100%的弹簧圈位于舌下神经管内的髁前静脉，54.2%位于斜坡下部外侧，而位于舌下神经管前口腹外侧的髁前汇合处的仅为14.2%。血管内弹簧圈栓塞是髁前DAVF患者的首选治疗方法。成功治疗后，所有弹簧圈均位于舌下神经管内的髁前静脉。
