Interventional Neuroradiology, The Fondation Adolphe de Rothschild Hospital, Paris, France
Neuroradiology, Karolinska Universitetssjukhuset, Stockholm, Sweden.
J Neurointerv Surg. 2021 Mar;13(3):278-283. doi: 10.1136/neurintsurg-2020-016888. Epub 2020 Nov 16.
Torcular dural sinus malformations (tDSMs) with arteriovenous shunts are rare congenital intracranial vascular malformations that carry a high rate of neurologic impairment and death in the neonatal, infant and young pediatric population. Their impact on brain venous drainage, especially the deep venous system, is one of the key factors in the clinical prognosis and natural history of the disease. We describe our therapeutic strategy for tDSMs, disconnecting the reflux into the deep venous system by performing an endovascular straight sinus occlusion.
Among all children with dural sinus malformations seen between 2002 and 2020, we retrospectively reviewed those with tDSM in whom straight sinus occlusion had been performed.
Our databank included nine patients with tDSM that were embolized. Mean age at the clinical onset was 8.9±9.6 months (min-max=0-31). Five patients presented a significant reflux in the straight sinus on digital subtraction angiography. Those patients were initially clinically worse (mean modified Rankin Scale (mRS) 3.8) than those who did not present with reflux (mean mRS 2.25), this reflux being responsible for intraventricular hemorrhage in three patients. The reflux was suppressed by transarterial embolization in one patient and by transvenous straight sinus occlusion in four patients. Staged endovascular treatment resulted in a complete cure in six patients without complications, and clinical improvement in all patients.
Straight sinus occlusion is a feasible technique that needs to be considered in the treatment strategy for tDSM with deep venous reflux in order to avoid or minimize brain damage.
伴有动静脉分流的硬脑膜窦畸形（tDSMs）是一种罕见的先天性颅内血管畸形，在新生儿、婴儿和幼儿人群中，其神经功能损害和死亡率很高。它们对脑静脉引流的影响，特别是对深部静脉系统的影响，是影响疾病临床预后和自然病史的关键因素之一。我们描述了通过血管内直窦闭塞来阻断反流进入深部静脉系统的 tDSM 治疗策略。
在 2002 年至 2020 年间就诊的所有硬脑膜窦畸形患儿中，我们回顾性分析了接受直窦闭塞治疗的 tDSM 患儿。
我们的数据库包括 9 例接受栓塞治疗的 tDSM 患儿。发病时的平均年龄为 8.9±9.6 个月（最小-最大=0-31 个月）。5 例患儿的数字减影血管造影（DSA）显示直窦存在明显反流。这些患儿的临床症状较严重（改良 Rankin 量表（mRS）评分为 3.8），而没有反流的患儿临床症状较轻（mRS 评分为 2.25），其中 3 例患儿因反流导致了脑室出血。1 例患儿通过动脉内栓塞治疗，4 例患儿通过静脉内直窦闭塞治疗抑制了反流。分期血管内治疗后，6 例患儿完全治愈，无并发症，所有患儿的临床症状均得到改善。
直窦闭塞是一种可行的技术，对于伴有深部静脉反流的 tDSM，需要在治疗策略中加以考虑，以避免或最小化脑损伤。
