Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia.
Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia.
J Clin Neurosci. 2020 Oct;80:232-237. doi: 10.1016/j.jocn.2020.08.021. Epub 2020 Aug 28.
Intracranial high-grade dural arteriovenous fistulas (DAVFs) have higher bleeding rates compared to other intracranial vascular malformations. Endovascular treatment is usually recommended for high-grade lesions, aiming at a complete fistula obliteration. However, some patients have vascular abnormalities that limit endovascular access to the precise location of the shunt. Alternative techniques may be considered in this scenario. A middle-aged man presented with intracranial hypertension secondary to a high-grade DAVF. Because of vascular abnormalities precluding transvenous access to the intracranial venous circulation, the patient required treatment by a direct transcranial coil and Onyx embolization of the shunt. Direct transcranial cannulation of a dural sinus is an alternative and effective route for transvenous embolization of DAVFs, especially if abnormal venous anatomy precluding venous access to the required cranial venous system is identified.
颅内高级硬脑膜动静脉瘘 (DAVF) 的出血率高于其他颅内血管畸形。通常建议对高级别病变进行血管内治疗，以实现完全瘘闭塞。然而，一些患者存在血管异常，限制了血管内进入分流的确切位置。在这种情况下，可以考虑替代技术。一名中年男子因颅内高压继发于高级别 DAVF 就诊。由于血管异常导致无法经静脉进入颅内静脉循环，该患者需要通过直接经颅线圈和 Onyx 栓塞分流进行治疗。直接经颅窦内插管是 DAVFs 经静脉栓塞的一种替代和有效途径，特别是如果存在异常静脉解剖结构，妨碍了所需颅静脉系统的静脉入路时。
