Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
World Neurosurg. 2020 Sep;141:15-19. doi: 10.1016/j.wneu.2020.05.198. Epub 2020 May 29.
Intraorbital arteriovenous fistulas (AVFs) are rare lesions, and their treatment is challenging. We have presented a case of an intraorbital AVF treated with endovascular embolization through the surgically accessed basal vein of Rosenthal.
A 53-year-old man had been referred to our hospital for an aneurysm-like lesion that was compressing the left optic chiasm. A left internal carotid angiogram demonstrated an orbital AVF fed by a distal segment of the ophthalmic arteries and the anterior branch of the inferolateral trunk that was drained solely into a tortuous basal vein of Rosenthal through a bridging vein of the left optic nerve sheath. Considering the risk of hemorrhagic complications during transvenous manipulation and visual complication in cases of transarterial embolization, combined surgical and transvenous embolization was attempted through the translocated basal vein of Rosenthal to bypass the dangerous path to the fistula. The lesion was directly catheterized through the translocated basal vein of Rosenthal after confirming visual tolerance to brief drainage occlusion using visual evoked potential monitoring, resulting in successful fistula obliteration using detachable coils.
Direct catheterization of the translocated deep draining vein was useful to bypass the dangerous access to the fistula and could be a feasible alternative strategy for treating selected AVFs.
眼眶动静脉瘘（AVF）是一种罕见的病变，其治疗具有挑战性。我们报告了一例通过经手术入路的 Rosenthal 基底静脉进行血管内栓塞治疗的眼眶 AVF 病例。
一名 53 岁男性因压迫左侧视交叉的类似动脉瘤样病变而被转诊至我院。左侧颈内动脉造影显示，由眼动脉远端段和下外侧干前支供血的眼眶 AVF，通过左侧视神经鞘桥接静脉仅引流至迂曲的 Rosenthal 基底静脉。考虑到经静脉操作过程中出血并发症的风险以及经动脉栓塞治疗时视力并发症的风险，尝试通过移位的 Rosenthal 基底静脉进行联合手术和经静脉栓塞，以绕过通往瘘口的危险路径。在使用视觉诱发电位监测确认短暂引流闭塞的视觉耐受后，通过移位的 Rosenthal 基底静脉直接对病变进行导管插入，成功使用可解脱线圈闭塞瘘口。
直接对移位的深部引流静脉进行导管插入术对于绕过通往瘘口的危险路径是有用的，可能是治疗特定 AVF 的一种可行的替代策略。
