From the Department of Radiology and Research Institute of Radiology (Z.Y.J., Y.S.S., J.J.S., J.G.K., D.H.L., D.C.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Radiology (Z.Y.J., Y.S.S.), The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.
AJNR Am J Neuroradiol. 2018 Dec;39(12):2301-2306. doi: 10.3174/ajnr.A5868. Epub 2018 Nov 1.
Pursuing an alternative access route for transvenous embolization of cavernous sinus dural arteriovenous fistulas can be challenging in patients with an occluded inferior petrosal sinus. We found that cannulation of even a completely occluded inferior petrosal sinus is feasible, especially when using a standard hydrophilic-polymer-jacketed 0.035-inch guidewire as a frontier-wire for probing.
From 2002 to 2017, the frontier-wire technique was tried in 52 patients with occluded inferior petrosal sinuses for transvenous embolization of cavernous sinus dural arteriovenous fistulas at our center. Technical success was defined as access into the affected cavernous sinus compartment with a microcatheter through the occluded inferior petrosal sinus and deployment of at least 1 coil. The complications and treatment outcomes were analyzed.
The frontier-wire technique was applied in 52 patients with 57 occluded inferior petrosal sinuses (52 ipsilateral and 5 contralateral inferior petrosal sinuses). Technical success rates were 80.8% (42/52) of patients and 73.7% (42/57) of inferior petrosal sinuses. Alternative transvenous routes were used in 3 patients, and transarterial access was used in 7 patients. Complete embolization of fistulas was achieved in 82.2% (37/45) of patients in the transvenous embolization group and in 14.3% (1/7) of patients in the transarterial group. No procedure-related morbidity or mortality was observed.
Transvenous embolization of cavernous sinus dural arteriovenous fistulas, even through a completely occluded inferior petrosal sinus, is feasible. The difficulty of passing the microcatheter can be minimized by prior probing of the occluded inferior petrosal sinus using a standard 0.035-inch guidewire; the trace of the guidewire on the roadmap image serves as a guide for microcatheter navigation through the inferior petrosal sinus on fluoroscopy.
对于下岩窦闭塞的海绵窦硬脑膜动静脉瘘患者，寻找一种替代的经静脉入路进行栓塞治疗可能具有挑战性。我们发现，即使是完全闭塞的下岩窦，也可以进行插管，特别是使用标准的亲水聚合物护套 0.035 英寸导丝作为探测的前沿导丝时更是如此。
2002 年至 2017 年，我们中心尝试了在 52 例下岩窦闭塞的患者中使用前沿导丝技术进行海绵窦硬脑膜动静脉瘘的经静脉栓塞治疗。技术成功定义为通过闭塞的下岩窦将微导管插入受累的海绵窦腔，并至少放置 1 个线圈。分析并发症和治疗结果。
该前沿导丝技术应用于 52 例 57 个闭塞的下岩窦（52 例同侧，5 例对侧）患者。患者的技术成功率为 80.8%（42/52），下岩窦的技术成功率为 73.7%（42/57）。有 3 例患者使用了替代的经静脉入路，7 例患者使用了经动脉入路。在经静脉栓塞组的 45 例患者中，有 82.2%（37/45）实现了瘘管完全栓塞，而在经动脉组的 7 例患者中，只有 14.3%（1/7）实现了瘘管完全栓塞。没有观察到与操作相关的发病率或死亡率。
即使是通过完全闭塞的下岩窦，也可以进行海绵窦硬脑膜动静脉瘘的经静脉栓塞治疗。通过使用标准的 0.035 英寸导丝预先探测闭塞的下岩窦，可以将微导管通过下岩窦的难度降到最低；导丝在 roadmap 图像上的轨迹可以作为微导管在透视下通过下岩窦导航的指南。
