Castro-Afonso Luís Henrique de, Trivelato Felipe Padovani, Rezende Marco Túlio, Ulhôa Alexandre Cordeiro, Nakiri Guilherme Seizem, Monsignore Lucas Moretti, Abud Daniel G
1 Division of Interventional Neuroradiology, University of São Paulo, São Paulo, Brazil.
2 Division of Interventional Neuroradiology, Felício Rocho Hospital and Clinics Hospital of Federal University of Minas Gerais, Belo Horizonte, Brazil.
Interv Neuroradiol. 2019 Feb;25(1):66-70. doi: 10.1177/1591019918796493. Epub 2018 Aug 30.
Multiple ways to access the dural carotid cavernous fistula have been described. The aim of the present study was to assess the results of embolization of a dural carotid cavernous fistula via different routes using endovascular accesses as a first-line strategy.
A retrospective data analysis of a consecutive series of 63 patients presenting with dural carotid cavernous fistula was performed.
The dural carotid cavernous fistula was accessed by an endovascular approach in 58 patients (92.1%) and by direct puncture in five patients (7.9%). The inferior petrosal sinus was the main route accessed (65%). A recanalization of an occluded inferior petrosal sinus was obtained in 20.6% of cases. The access via either facial ophthalmic veins or the superior petrosal sinus was obtained in 20.6% and 3.1% of cases, respectively. Complete angiographic occlusion of a dural carotid cavernous fistula immediately after treatment was achieved in 53 patients (84.1%), whereas 10 patients (15.9%) displayed a partial occlusion. Treatment-related complications were observed in two patients (3.2%).
In this study, the endovascular approach allowed dural carotid cavernous fistula embolization in most patients. The inferior petrosal sinus, even when thrombosed, was the main route used to access the dural carotid cavernous fistula, followed by the facial vein, direct cavernous sinus puncture, and the superior petrosal sinus.
已描述了多种进入硬脑膜动静脉瘘的方法。本研究的目的是评估以血管内入路作为一线策略，通过不同途径栓塞硬脑膜动静脉瘘的结果。
对连续63例硬脑膜动静脉瘘患者进行回顾性数据分析。
58例患者（92.1%）通过血管内入路进入硬脑膜动静脉瘘，5例患者（7.9%）通过直接穿刺进入。岩下窦是主要的进入途径（65%）。20.6%的病例实现了闭塞岩下窦的再通。分别有20.6%和3.1%的病例通过面眼静脉或岩上窦进入。53例患者（84.1%）在治疗后立即实现了硬脑膜动静脉瘘的完全血管造影闭塞，而10例患者（15.9%）显示部分闭塞。2例患者（3.2%）观察到与治疗相关的并发症。
在本研究中，血管内入路使大多数患者能够进行硬脑膜动静脉瘘栓塞。岩下窦即使血栓形成，也是进入硬脑膜动静脉瘘的主要途径，其次是面静脉、海绵窦直接穿刺和岩上窦。
