Rhim Jong Kook, Cho Young Dae, Park Jeong Jin, Jeon Jin Pyeong, Kang Hyun-Seung, Kim Jeong Eun, Cho Won-Sang, Han Moon Hee
Departments of *Radiology and ‡Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Neurosurgery. 2015 Aug;77(2):192-9; discussion 199. doi: 10.1227/NEU.0000000000000751.
Although a transvenous route via the ipsilateral inferior petrosal sinus (IPS) is preferred in treating cavernous sinus dural arteriovenous fistula (CSdAVF), this option may be limited if an occluded ipsilateral IPS undermines microcatheter delivery to the cavernous sinus.
To describe our experience with endovascular treatment of CSdAVF complicated by ipsilateral IPS occlusion.
From January 2003 through September 2014, a total of 49 CSdAVFs with ipsilateral IPS occlusion were identified in 49 patients, who then underwent endovascular treatment. Clinical and radiologic data were retrospectively reviewed.
Either transvenous (n = 38) or transarterial (n = 11) access was initially elected, the latter reserved for single-hole or dominant arterial feeder fistulas. Access via occluded ipsilateral IPS was usually attempted (n = 34) by transvenous approach, with a 54.3% success rate. Anterior (n = 3) or posterior (n = 1) facial vein was alternatively used. Direct surgical exposure of ophthalmic vein (n = 3) or radiosurgery (n = 4) was performed for access failure or unsuccessful occlusion by other means. In 46 fistulas (93.9%), complete occlusion was achieved, with no procedure-related morbidity or mortality. Postprocedural symptom improvement was noted in all but 2 patients, who separately experienced paradoxical worsening of cranial nerve palsy and access failure.
In patients with CSdAVF and ipsilateral IPS occlusion, various treatment strategies may be applied (given angioanatomic suitability), resulting in excellent procedural and short-term follow-up results. Reopening of an occluded IPS is reasonable as an initial access attempt.
尽管经同侧岩下窦（IPS）的经静脉途径在治疗海绵窦硬脑膜动静脉瘘（CSdAVF）中是首选方法，但如果同侧IPS闭塞，会影响微导管进入海绵窦，这种方法可能会受到限制。
描述我们对合并同侧IPS闭塞的CSdAVF进行血管内治疗的经验。
从2003年1月至2014年9月，在49例患者中总共识别出49例合并同侧IPS闭塞的CSdAVF，随后这些患者接受了血管内治疗。对临床和影像学资料进行回顾性分析。
最初选择经静脉途径（n = 38）或经动脉途径（n = 11），后者用于单孔或主要动脉供血瘘。通常尝试经静脉途径通过闭塞的同侧IPS进入（n = 34），成功率为54.3%。可选择使用面前静脉（n = 3）或面后静脉（n = 1）。对于进入失败或其他方法闭塞不成功的情况，可直接手术暴露眼静脉（n = 3）或进行放射外科治疗（n = 4）。在46例瘘（93.9%）中实现了完全闭塞，无手术相关的发病率或死亡率。除2例患者外，所有患者术后症状均有改善，这2例患者分别出现了颅神经麻痹矛盾性加重和进入失败的情况。
对于合并同侧IPS闭塞的CSdAVF患者，（根据血管解剖情况）可应用多种治疗策略，从而获得良好的手术效果和短期随访结果。作为初始进入尝试，重新开通闭塞的IPS是合理的。
