Oh Jae-Sang, Yoon Seok-Mann, Shim Jai-Joon, Bae Hack-Gun
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
J Korean Neurosurg Soc. 2015 Jan;57(1):54-7. doi: 10.3340/jkns.2015.57.1.54. Epub 2015 Jan 31.
A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.
一名66岁女性出现间歇性双下肢轻瘫和全身性强直阵挛发作。脑血管造影显示硬脑膜动静脉瘘（AVF）累及上矢状窦（SSS），且与后三分之一的上矢状窦闭塞有关。该硬脑膜AVF由双侧脑膜中动脉（MMA）、颞浅动脉（STA）和枕动脉供血，伴有明显的皮质静脉逆行回流。通过右侧MMA和STA进行了经股动脉Onyx栓塞，但未成功，由于MMA迂曲，微导管无法足够接近瘘口，导致硬脑膜AVF部分闭塞。一周后，使用金刚石钻头在覆盖MMA的颅骨上进行小范围去骨皮质后，通过直接穿刺MMA进入左侧MMA进行了第二次手术。通过置于MMA的5F鞘管，微导管能够置于瘘口远端，使用3.9 cc Onyx实现了硬脑膜AVF的完全闭塞。
