Division of Interventional Neuroradiology, Houston Methodist Research Institute, Houston, Texas, USA.
Department of Endovascular/Cerebrovascular Surgery, Sacred Heart Health System, Pensacola, Florida, USA.
J Neurointerv Surg. 2018 Dec;10(12):1179-1182. doi: 10.1136/neurintsurg-2018-013845. Epub 2018 Jun 16.
To report percutaneous transcranial puncture, embolization and occlusion of a very symptomatic hypoglossal canal/anterior condylar vein dural arteriovenous fistula (DAVF) using syngo iGuide navigational software in a patient in whom transarterial and transvenous embolization and surgery had failed.
After unsuccessful arterial and venous embolization and surgical treatment of a symptomatic hypoglossal canal DAVF, a 47-year-old man was transferred for further management. With exquisite anatomic detail provided by C-arm cone-beam computed tomography (CBCT) equipment (Artis zee Biplane, Dyna CT VC21H, Siemens Healthcare GmbH, Germany) and syngo iGuide needle guidance navigational software (Siemens Healthcare GmbHy) for planning a safe direct approach, the hypoglossal/anterior condylar vein, the dominant outflow vein of the fistula, was needle punctured percutaneously at the hypoglossal foramen and occluded with ethylene vinyl alcohol copolymer liquid embolic agent (Onyx, Medtronic, Minneapolis, Minnesota, USA) after placing two anchoring platinum coils (Target detachable coils, Stryker Neurovascular, Fremont, California, USA).
After a year of progressively severe left eye proptosis, chemosis and increased intraocular pressure, the symptoms quickly subsided after this embolization and the patient was symptom free at his 3-month and later checkups.
With guidance and imaging provided by CBCT and syngo iGuide navigational software, an otherwise untreatable DAVF was successfully embolized and obliterated by an aggressive unique percutaneous trans-cranial needle puncture of the dominant outflow vein in the hypoglossal canal.
报告使用 syngo iGuide 导航软件对一例经动脉和静脉栓塞及手术治疗均失败的症状性舌下神经管/前髁突静脉硬脑膜动静脉瘘（DAVF）患者进行经颅穿刺、栓塞和闭塞。
一名 47 岁男性患者出现症状性舌下神经管 DAVF，在进行了不成功的动脉和静脉栓塞及手术治疗后转来进一步治疗。使用 C 臂锥形束 CT（CBCT）设备（Artis zee Biplane、Dyna CT VC21H、Siemens Healthcare GmbH，德国）和 syngo iGuide 针引导导航软件（Siemens Healthcare GmbHy）提供的精细解剖细节，规划安全的直接入路，经舌下神经管对舌下/前髁突静脉，即瘘的优势流出静脉进行经皮穿刺，并在放置两个锚固铂金线圈（Target detachable coils，Stryker Neurovascular，Fremont，加利福尼亚州，美国）后用乙烯-乙烯醇共聚物液体栓塞剂（Onyx，Medtronic，明尼苏达州明尼阿波利斯，美国）闭塞。
在左眼进行性严重突出、球结膜水肿和眼内压升高一年后，经栓塞治疗后症状迅速缓解，患者在 3 个月及以后的随访中无任何症状。
在 CBCT 和 syngo iGuide 导航软件的引导和成像下，通过积极的独特经颅穿刺舌下神经管内优势流出静脉，成功栓塞和闭塞了原本无法治疗的 DAVF。
