Shimizu Yu
Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, 2 Chome-8-1 Yotsui, Fukui, 910-8526, Japan.
J Clin Neurosci. 2021 Feb;84:106-110. doi: 10.1016/j.jocn.2020.11.019. Epub 2020 Dec 24.
Dural carotid-cavernous fistulas (DCCF) are located in the cavernous sinus wall involving the arterial feeders from the external and internal carotid arteries. The venous route usually passes through the internal jugular vein and inferior petrosal sinus (IPS) up to the pathologic shunts of the cavernous sinus. In cases of a thrombosed IPS, catheterization is not always possible because of the obstruction. Here, we report eight cases of DCCF treated with endovascular transvenous embolization via the superficial middle temporal vein (SMTV). A retrospective study involving eight patients with DCCF treated with transvenous embolization via SMTV was performed. In six patients, IPS was thrombosed. In one patient, IPS was patent, but we could not catheterize the internal jugular vein. In the other patient, because of the compartmentalization of the cavernous sinus, we could not access the anterior part of the cavernous sinus via IPS. Therefore, we performed the embolization via SMTV to occlude the shunts of the anterior part of the cavernous sinus. In all eight cases, navigating through the tortuous junction of the angular vein and superior ophthalmic vein (SOV) was possible. After transvenous catheterization of the cavernous sinus via SMTV, placement of coils resulted in complete occlusion of DCCF with clinical improvement in all eight patients. In the endovascular treatment of DCCF, the transfemoral approach via SMTV provides a pivotal route alternative to other transvenous routes. In patients with dilated SOV, catheterization of the cavernous sinus via SMTV is usually successful.
硬脑膜海绵窦瘘（DCCF）位于海绵窦壁，涉及来自颈外动脉和颈内动脉的供血动脉。静脉途径通常经颈内静脉和岩下窦（IPS）直至海绵窦的病理性分流处。在IPS血栓形成的情况下，由于阻塞，导管插入术并非总是可行。在此，我们报告8例经颞中浅静脉（SMTV）行血管内静脉栓塞治疗的DCCF病例。对8例经SMTV行静脉栓塞治疗的DCCF患者进行了回顾性研究。6例患者IPS血栓形成。1例患者IPS通畅，但我们无法插入颈内静脉导管。另一例患者，由于海绵窦的分隔，我们无法经IPS进入海绵窦前部。因此，我们经SMTV进行栓塞以闭塞海绵窦前部的分流。在所有8例病例中，均能够通过迂曲的角静脉与眼上静脉（SOV）交界处进行操作。经SMTV对海绵窦进行静脉导管插入术后，放置弹簧圈导致DCCF完全闭塞，所有8例患者的临床症状均有改善。在DCCF的血管内治疗中，经SMTV的经股动脉途径为其他静脉途径提供了关键的替代途径。在SOV扩张的患者中，经SMTV对海绵窦进行导管插入术通常是成功的。
