Sato Hirotaka, Miyachi Shigeru, Hashimoto Atsumu, Kinoshita Yu, Wada Hajime, Kamada Kyosuke, Tanikawa Rokuya, Kamiyama Hiroyasu
Department of Neurosurgery, Asahikawa Medical University.
No Shinkei Geka. 2019 Jul;47(7):777-783. doi: 10.11477/mf.1436204022.
Intraorbital dural arteriovenous fistula(dAVF)is a very rare disease; therefore, an optimal treatment strategy has not yet been established. Here, we describe a case of successful dAVF treatment by performing transarterial embolization(TAE)with n-butyl-2-cyanoacrylate(NBCA). A 66-year-old male presented with right conjunctival injection, with no history of trauma. Magnetic resonance imaging(MRI)demonstrated a flow void in the right orbit. Digital subtraction angiography(DSA)revealed an AVF fed by a branch of the right ophthalmic artery(OA)and draining into the dilated right superior ophthalmic vein(SOV). A transvenous embolization(TVE)was planned, but it could not be performed because the facial vein was meandering. Hence, TAE with NBCA was performed, and the AVF was successfully occluded by this method. There has been no recurrence of intraorbital dAVF in three months since the treatment. Several recent studies have reported that TAE is an effective treatment for intracranial dAVF. However, there are insufficient reports of TAE with NBCA for intraorbital dAVF treatment. The anatomy of the OA needs to be known for the success of TAE in treating intraorbital dAVF, because TAE is a high-risk treatment. In this paper, we report a case wherein TAE with NBCA was performed for intraorbital dAVF and further review the other treatment options.
眶内硬脑膜动静脉瘘（dAVF）是一种非常罕见的疾病；因此，尚未确立最佳治疗策略。在此，我们描述一例通过使用氰基丙烯酸正丁酯（NBCA）进行经动脉栓塞术（TAE）成功治疗dAVF的病例。一名66岁男性，无外伤史，出现右眼结膜充血。磁共振成像（MRI）显示右眼眶有血流空信号。数字减影血管造影（DSA）显示一个由右眼动脉（OA）分支供血并引流至扩张的右眼上静脉（SOV）的动静脉瘘。原本计划进行经静脉栓塞术（TVE），但由于面静脉迂曲而无法实施。因此，进行了NBCA的TAE，通过该方法成功闭塞了动静脉瘘。治疗后三个月，眶内dAVF未复发。最近的几项研究报道，TAE是治疗颅内dAVF的有效方法。然而，关于使用NBCA进行TAE治疗眶内dAVF的报道不足。由于TAE是一种高风险治疗方法，为成功治疗眶内dAVF，需要了解眼动脉的解剖结构。在本文中，我们报告了一例使用NBCA进行TAE治疗眶内dAVF的病例，并进一步回顾了其他治疗选择。
