Shimizu Yu, Tokuda Kazuhiko, Park Cheho
Department of Neurosurgery, Japan Organization of Occupational Health and Safety Toyama Rousai Hospital, Toyama, Japan.
Surg Neurol Int. 2020 Dec 16;11:438. doi: 10.25259/SNI_571_2020. eCollection 2020.
Sphenoid wing dural arteriovenous fistula (SWDAVF) is rare that is typically fed by middle meningeal artery feeders and that drain through the sphenoparietal sinus or middle cerebral vein. Here, we report a case of SWDAVF treated by coils placed in the venous aneurysm through the contralateral cavernous sinus (CS).
A 37-year-old woman was admitted to our hospital with headache and bilateral oculomotor nerve palsy. Magnetic resonance images and an angiogram showed a venous aneurysm in the right middle cranial fossa. A DAVF, consisting of two main feeders, was diagnosed based on the angiogram findings. The fistula drained into the left inferior petrosal sinus (IPS) through the left CS and right IPS. Given the remarkable extent of venous ectasia together with the headache and right abducens nerve paralysis, endovascular treatment was initiated. A transvenous approach through the right IPS was not feasible, as it is strenuous to insert the microcatheter into the right IPS. Thus, we tried an approach through the left IPS. The venous aneurysm was embolized with coils. The postoperative course was uneventful, and postoperative cerebral angiography confirmed disappearance of the fistula.
A SWDAVF is extremely rare. In our case, since the AVF drained into the contralateral CS, contralateral ocular symptoms occurred. Endovascular occlusion of the venous aneurysm and fistula was achieved through a transvenous approach.
蝶骨嵴硬脑膜动静脉瘘（SWDAVF）较为罕见，通常由脑膜中动脉供血，经蝶顶窦或大脑中静脉引流。在此，我们报告一例通过经对侧海绵窦（CS）将弹簧圈置入静脉瘤治疗SWDAVF的病例。
一名37岁女性因头痛和双侧动眼神经麻痹入院。磁共振成像和血管造影显示右侧中颅窝有一个静脉瘤。根据血管造影结果诊断为一个由两个主要供血动脉组成的硬脑膜动静脉瘘（DAVF）。该瘘经左侧CS和右侧岩下窦（IPS）引流至左侧岩下窦。鉴于静脉扩张程度显著以及头痛和右侧展神经麻痹，启动了血管内治疗。经右侧IPS的经静脉入路不可行，因为将微导管插入右侧IPS很困难。因此，我们尝试了经左侧IPS的入路。用弹簧圈栓塞静脉瘤。术后过程顺利，术后脑血管造影证实瘘消失。
SWDAVF极为罕见。在我们的病例中，由于动静脉瘘引流至对侧CS，出现了对侧眼部症状。通过经静脉入路实现了静脉瘤和瘘的血管内闭塞。
