Gioppo Andrea, Faragò Giuseppe, Caldiera Valentina, Caputi Luigi, Cusin Alberto, Ciceri Elisa
Department of Neuroradiology, Interventional Unit, IRCCS Foundation Neurological Institute "C. Besta", Milano, Italy; Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy.
Department of Neuroradiology, Interventional Unit, IRCCS Foundation Neurological Institute "C. Besta", Milano, Italy.
World Neurosurg. 2017 Nov;107:1050.e1-1050.e7. doi: 10.1016/j.wneu.2017.08.050. Epub 2017 Aug 18.
Tentorial dural arteriovenous fistulas (DAVFs) are uncommon, complex fistulas located between the leaves of the tentorium cerebelli with a specific anatomic and clinical presentation characterized by high hemorrhagic risk. We present a rare case of a medial tentorial DAVF successfully managed via transarterial embolization using SQUID liquid polymer.
A 60-year-old woman presented with a history of left progressive hearing loss and tinnitus for >1 year. Cerebral angiography demonstrated the presence of a medial tentorial DAVF with multiple arterial feeders, including the artery of Davidoff and Schechter; reverse venous outflow was observed in the inferior sagittal sinus and in multiple cortical veins. The patient underwent transarterial embolization with SQUID liquid polymer, an embolic agent that provides 2 different viscous formulations to cast the DAVF. The procedure went well without any complication, and the patient regained her preoperative status. In the postprocedural period, the patient experienced complete resolution of tinnitus. At 6 months, she remained asymptomatic, and cerebral angiography confirmed complete, stable occlusion of the fistula and normalization of cerebral deep venous outflow.
Medial tentorial DAVFs are considered the most complex DAVFs because of their location and extensive vascular supply. Our literature review focused on endovascular treatment of tentorial DAVFs to highlight the usefulness of new embolic agents in management of these diseases. To our knowledge, we report the first successful use of SQUID liquid polymer in management of a tentorial DAVF.
小脑幕硬脑膜动静脉瘘（DAVF）并不常见，是位于小脑幕叶间的复杂瘘管，具有特定的解剖学和临床表现，出血风险高。我们报告一例罕见的小脑幕内侧DAVF，通过使用鱿鱼液体聚合物经动脉栓塞成功治疗。
一名60岁女性，有超过1年的左侧进行性听力丧失和耳鸣病史。脑血管造影显示存在小脑幕内侧DAVF，有多个动脉供血，包括大卫多夫动脉和谢克特动脉；在下矢状窦和多条皮质静脉中观察到静脉逆流。患者接受了使用鱿鱼液体聚合物的经动脉栓塞治疗，该栓塞剂提供两种不同的粘性配方以封堵DAVF。手术顺利，无任何并发症，患者恢复到术前状态。在术后期间，患者耳鸣完全消失。6个月时，她仍无症状，脑血管造影证实瘘管完全、稳定闭塞，脑深部静脉流出正常化。
由于其位置和广泛的血管供应，小脑幕内侧DAVF被认为是最复杂的DAVF。我们的文献综述聚焦于小脑幕DAVF的血管内治疗，以突出新型栓塞剂在这些疾病管理中的作用。据我们所知，我们首次报告了成功使用鱿鱼液体聚合物治疗小脑幕DAVF。
