Matsumoto Atsushi, Okauchi Masanobu, Shindo Atsushi, Kawanishi Masahiko, Tamiya Takashi
Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Japan.
Interv Neuroradiol. 2017 Jun;23(3):301-306. doi: 10.1177/1591019917693413. Epub 2017 Jan 1.
Introduction In case of cavernous sinus dural arteriovenous fistula (CSDAVF), transvenous embolization (TVE) of the cavernous sinus (CS) via the inferior petrosal sinus (IPS) is generally performed. However, various approach routes have been reported when the accessibility of the IPS is challenging. We herein report a case of CSDAVF treated by TVE with direct puncture of the facial vein. Case report A 70-year-old woman who suffered from tinnitus, chemosis, diplopia and bruit was referred to our hospital. Digital subtraction angiography (DSA) demonstrated CSDAVF. We initially attempted to perform TVE via the IPS route; however, we could not guide a catheter to the CS because of an anatomical difficulty. Then, we performed percutaneous direct puncture of the dilated facial vein, and successfully treated the patient. Conclusion When navigating microcatheter to the CS is difficult because of an anatomical difficulty of the IPS, direct puncture of the facial vein is a feasible route.
对于海绵窦硬脑膜动静脉瘘（CSDAVF），通常经岩下窦（IPS）对海绵窦（CS）进行经静脉栓塞（TVE）。然而，当IPS难以到达时，已有多种入路途径的报道。我们在此报告一例通过直接穿刺面静脉进行TVE治疗的CSDAVF病例。病例报告：一名70岁女性，患有耳鸣、结膜充血、复视和血管杂音，转诊至我院。数字减影血管造影（DSA）显示为CSDAVF。我们最初试图通过IPS途径进行TVE；然而，由于解剖学上的困难，我们无法将导管引导至CS。然后，我们对扩张的面静脉进行经皮直接穿刺，并成功治疗了该患者。结论：当由于IPS的解剖学困难而难以将微导管导航至CS时，直接穿刺面静脉是一种可行的途径。
