Iampreechakul Prasert, Wangtanaphat Korrapakc, Lertbutsayanukul Punjama, Wattanasen Yodkhwan, Siriwimonmas Somkiet
Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand.
Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand.
Asian J Neurosurg. 2019 Nov 25;14(4):1268-1274. doi: 10.4103/ajns.AJNS_277_19. eCollection 2019 Oct-Dec.
The authors describe a patient with spontaneous closure of a spontaneous cavernous sinus dural arteriovenous fistula (CSDAVF), Cognard type V, during transvenous attempt. A 39-year-old woman experienced mild proptosis, redness of the left eye, and diplopia. Four months later, she developed left retro-orbital pain and left-sided headache. Cerebral angiography revealed the left CSDAVF exclusively draining into the superior petrosal sinus with subsequent drainage into the veins surrounding the medulla oblongata, and finally into the perimedullary spinal veins, classified as Cognard type V. The feeders arise from the dural branches of both the left external and internal carotid arteries. Following 2 h period of attempted transvenous embolization, the fistula disappeared spontaneously. Follow-up angiography obtained 6 months later confirmed complete resolution of the CSDAVF. At 2-year follow-up, the patient has remained clinically asymptomatic. The mechanism of thrombosis in this fistula related to the endovascular procedure. We speculated that putting the wire tip in the draining vein may induce the spontaneous thrombosis in the venous side. In addition, precipitating factors may include small, low-flow fistula, and pre-existing thrombosis.
作者描述了1例在经静脉栓塞尝试过程中，自发性海绵窦硬脑膜动静脉瘘（CSDAVF）（Cognard V型）出现自发闭合的患者。一名39岁女性出现轻度眼球突出、左眼发红和复视。4个月后，她出现左眶后疼痛和左侧头痛。脑血管造影显示左侧CSDAVF仅引流至岩上窦，随后引流至延髓周围静脉，最后引流至延髓周围脊髓静脉，分类为Cognard V型。供血动脉来自左颈外动脉和颈内动脉的硬脑膜分支。在尝试经静脉栓塞2小时后，瘘口自发消失。6个月后进行的随访血管造影证实CSDAVF完全消失。在2年的随访中，患者临床无症状。该瘘口血栓形成的机制与血管内操作有关。我们推测将导线尖端置于引流静脉中可能会诱发静脉侧的自发血栓形成。此外，促发因素可能包括小的、低流量的瘘口以及既往存在的血栓形成。
