Matsuo Kazuya, Fujita Atsushi, Kohta Masaaki, Kohmura Eiji
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Radiol Case Rep. 2020 Feb 7;15(4):405-410. doi: 10.1016/j.radcr.2020.01.018. eCollection 2020 Apr.
We present a unique sinus protection technique that uses a short-length supercompliant balloon during the transarterial Onyx embolization for the dural arteriovenous fistula (DAVF) of the lateral tentorial sinus. With this technique, we temporarily change the Borden classification from type II to type III, avoiding venous compromise and reducing the risk of Onyx migration into the patent sinus. A 54-year-old man presented with left persistent tinnitus of 4 months' duration. Cerebral angiography revealed a Borden type II left lateral tentorial sinus-DAVF associated with retrograde cortical venous reflux draining into the vein of Labbé. In the venous phase, the ipsilateral transverse-sigmoid sinus was recognized as a functional sinus and the posterior temporal vein drained into the transverse sinus near the drainage channel. We planned to perform transarterial Onyx embolization using a short-length sinus protection balloon to protect against Onyx migration. During transarterial Onyx injection, a 7 × 7-mm HyperForm balloon was navigated into the affected sinus and positioned to cover the drainage channel from the shunt. After confirming the change in Borden classification with angiography, transarterial Onyx embolization was performed via the middle meningeal artery. This procedure resulted in complete obliteration of the fistula with good patency of both the transverse-sigmoid sinus and neighboring normal cortical veins. No procedure-related complications were observed and the patient remained free of recurrence during the 24-month follow-up period. Short-length balloon-protected Onyx embolization can be safe and effective for the treatment of Borden type II DAVF.
我们介绍了一种独特的窦保护技术，该技术在经动脉使用奥尼克斯（Onyx）栓塞外侧幕窦的硬脑膜动静脉瘘（DAVF）过程中，采用短长度超顺应性球囊。通过该技术，我们可将博登（Borden）分类暂时从II型转变为III型，避免静脉受压，并降低奥尼克斯迁移至开放窦内的风险。一名54岁男性，持续左耳耳鸣4个月。脑血管造影显示为博登II型左侧外侧幕窦DAVF，伴有逆行皮质静脉回流至Labbe静脉。在静脉期，同侧横窦-乙状窦被确认为功能性窦，颞后静脉在引流通道附近汇入横窦。我们计划使用短长度窦保护球囊进行经动脉奥尼克斯栓塞，以防止奥尼克斯迁移。在经动脉注入奥尼克斯期间，将一个7×7毫米的HyperForm球囊送入患侧窦内，并定位以覆盖分流的引流通道。经血管造影确认博登分类改变后，经脑膜中动脉进行经动脉奥尼克斯栓塞。该操作使瘘完全闭塞，横窦-乙状窦及相邻正常皮质静脉通畅良好。未观察到与操作相关的并发症，患者在24个月随访期内无复发。短长度球囊保护下的奥尼克斯栓塞治疗博登II型DAVF安全有效。
