Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Oper Neurosurg (Hagerstown). 2021 Mar 15;20(4):E290-E291. doi: 10.1093/ons/opaa454.
This case is a 66-yr-old woman with a 2-mo history of left-sided tinnitus. Workup with magnetic resonance angiography showed early opacification of the left sigmoid sinus and internal jugular vein as well as asymmetric and abundant opacification of the left external carotid artery branches, suspicious for a dural arteriovenous fistula (dAVF). Diagnosis was confirmed with cerebral angiography, consistent with a left-sided Cognard type I dAVF.1 Initial treatment attempt was made with transarterial 6% ethylene-vinyl alcohol copolymer (Onyx 18) embolization of feeders from the occipital and middle meningeal arteries. However, embolization was not curative and there was a recurrence of a highly bothersome tinnitus 3 wk following treatment. Angiography redemonstrated the transverse sinus dAVF with new recruitment arising from several feeders, including the left external carotid artery, middle meningeal artery, and superficial temporal artery, now Cognard type IIa. Definitive treatment through a transvenous coil embolization provided permanent obliteration of the fistula without recrudescence of symptoms on follow-up. In this video, the authors discuss the nuances of treating a dAVF via a transvenous embolization. Patient consent was given prior to the procedure, and consent and approval for this operative video were waived because of the retrospective nature of this manuscript and the anonymized video material.
本病例为 66 岁女性，有 2 个月的左侧耳鸣史。磁共振血管造影检查显示左侧乙状窦和颈内静脉早期显影，左侧颈外动脉分支显影不对称且丰富，提示为硬脑膜动静脉瘘（dAVF）。脑血管造影确诊为左侧 Cognard Ⅰ型 dAVF。1 最初尝试经动脉用 6%乙烯-乙烯醇共聚物（Onyx 18）栓塞枕动脉和脑膜中动脉的供血动脉，但栓塞不完全，治疗后 3 周耳鸣再次高度困扰。血管造影显示横窦 dAVF，新出现的多个供血动脉包括左侧颈外动脉、脑膜中动脉和颞浅动脉，现为 Cognard Ⅱa 型。通过经静脉弹簧圈栓塞进行确定性治疗，可永久性闭塞瘘口，随访时症状无复发。在本视频中，作者讨论了经静脉栓塞治疗 dAVF 的细节。在进行该手术前，患者已同意，由于本文为回顾性，且视频资料已匿名，故豁免了患者知情同意和手术视频审批。
