Lammy Simon, Bhattacharya Joti, Dervin James, St George Edward Jerome
Department of Neurosurgery, Institute of Neurological Sciences, The Southern General Hospital, Glasgow G51 4TF, United Kingdom.
Department of Neuroradiology, Institute of Neurological Sciences, The Southern General Hospital, Glasgow G51 4TF, United Kingdom.
Asian J Neurosurg. 2018 Jul-Sep;13(3):946-948. doi: 10.4103/ajns.AJNS_330_16.
This technical note describes a direct puncture of the superior sagittal sinus (SSS) to treat a complex dural arteriovenous fistula (dAVF). A 40-year-old female was admitted having a history of increasing confusion. Computer tomography revealed enlargement of the right superior ophthalmic vein and magnetic resonance imaging demonstrated extensive bilateral hemispheric venous engorgement. Digital subtraction angiography (DSA) demonstrated a high flow dAVF involving the right transverse sinus. There was extensive cortical venous rerouting with venous sinus occlusion at the right transverse and sigmoid junction. Under general anesthesia, the sinus was exposed and catheterized. The angiography catheter was fed over the guide wire into the sinus. The remaining right sigmoid and transverse sinus were obliterated using a combination of microcoils and Onyx. She made a good postoperative recovery, and a repeat DSA at 30 days postoperatively showed evidence of the meningohypophyseal trunk but complete occlusion of the fistula. A check DSA 2 years later confirmed no evidence of a residual fistula. Our case demonstrates the potential use of the SSS as a novel conduit to treat distant targets.
本技术说明描述了一种通过直接穿刺上矢状窦（SSS）来治疗复杂硬脑膜动静脉瘘（dAVF）的方法。一名40岁女性因意识障碍加重入院。计算机断层扫描显示右眼上静脉增粗，磁共振成像显示双侧大脑半球广泛静脉充血。数字减影血管造影（DSA）显示右侧横窦存在高流量dAVF。在右侧横窦与乙状窦交界处存在广泛的皮质静脉改道及静脉窦闭塞。在全身麻醉下，暴露并穿刺该静脉窦，将血管造影导管经导丝送入静脉窦。使用微线圈和Onyx联合闭塞剩余的右侧乙状窦和横窦。患者术后恢复良好，术后30天复查DSA显示脑膜垂体干存在，但瘘口完全闭塞。2年后复查DSA证实无残余瘘口迹象。我们的病例表明上矢状窦作为一种新型管道治疗远处靶点具有潜在应用价值。
