Doolan Brent J, Paldor Iddo, Mitchell Peter J, Morokoff Andrew P
Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
J Clin Neurosci. 2018 Feb;48:214-217. doi: 10.1016/j.jocn.2017.10.070. Epub 2017 Nov 11.
Intracranial dural arteriovenous fistulae (DAVF) are complex vascular malformations consisting of a pathological shunt located between meningeal arteries and drainage to dural venous sinuses and/or cerebral veins. We report an unusual anatomical variation, resulting in a DAVF forming between the superior sagittal sinus and an anomalous origin of the middle meningeal artery (MMA) arising from the left ophthalmic artery. We present an atypical case requiring mini-craniotomy for catheter access, as well as cannulation of extracranial arterial supply prior to embolization of a Cognard type IIa+b fistula. Due to structural variation, transarterial endovascular embolization was deemed too high risk owing to risk of permanent blindness. We present a technical note and literature review on the first documented case of combined endovascular and surgical intervention as first line treatment for embolization of an anomalous middle meningeal artery related fistula. Our approach provided adequate obliteration of the DAVF and may be an alternative way to treat DAVF, when traditional transarterial or transvenous approaches are deemed high risk for neurological deficit.
颅内硬脑膜动静脉瘘（DAVF）是一种复杂的血管畸形，由位于脑膜动脉与硬脑膜静脉窦和/或脑静脉引流之间的病理性分流组成。我们报告了一种不寻常的解剖变异，导致在矢状窦上和起源于左眼动脉的脑膜中动脉（MMA）异常起始处之间形成了一个DAVF。我们展示了一个非典型病例，该病例需要进行微创开颅以建立导管通路，并在栓塞Cognard IIa + b型瘘之前对颅外动脉供血进行插管。由于结构变异，经动脉血管内栓塞因存在永久性失明风险而被认为风险过高。我们提供了一份技术说明和文献综述，介绍了首例记录在案的将血管内和外科干预联合作为一线治疗方法来栓塞与异常脑膜中动脉相关的瘘的病例。我们的方法实现了对DAVF的充分闭塞，当传统的经动脉或经静脉方法被认为存在神经功能缺损的高风险时，这可能是治疗DAVF的一种替代方法。
