Radiology, New York University Langone Health, New York, New York, USA.
Radiology, New York University Langone Health, New York, New York, USA
J Neurointerv Surg. 2021 Dec;13(12):1190. doi: 10.1136/neurintsurg-2020-017118. Epub 2021 Mar 8.
Cavernous sinus dural arteriovenous fistulas (CS-DAVF) can have an indolent course, with insidious onset, but still showing a high likelihood of spontaneous resolution.1 Nevertheless, symptoms in a subset of patients evolve more rapidly, with malignant signs on imaging, warranting intervention.2 We report on a patient in his 40s presenting with redness and proptosis of the right eye, intermittent blurred vision and diplopia. Once ophthalmological examination revealed increased intraocular pressure and imaging showed cortical venous congestion, the decision was made to obliterate a CS-DAVF involving the posteromedial right cavernous sinus.Multiple arteries including branches of the ascending pharyngeal artery, occipital artery and bilateral meningohypophyseal trunks supplied the fistula. Once transarterial embolization was deemed unsafe and both inferior petrosal sinuses did not grant access to the right cavernous sinus, a direct puncture to the cavernous sinus was performed to successfully coil the involved compartments.3-5 The aid of DynaCT imaging and needle guidance software is emphasized (video 1). neurintsurg;13/12/1190/V1F1V1Video 1.
海绵窦硬脑膜动静脉瘘（CS-DAVF）可能呈惰性病程，起病隐匿，但仍有很高的自发缓解可能性。1 然而，一部分患者的症状会更快进展，影像学上出现恶性征象，需要介入治疗。2 我们报告了一位 40 多岁的患者，表现为右眼发红、突出，间歇性视力模糊和复视。一旦眼科检查发现眼内压升高，影像学显示皮质静脉充血，就决定闭塞累及右侧海绵窦后内侧的 CS-DAVF。多个动脉包括咽升动脉、枕动脉和双侧脑膜垂体干的分支为瘘供血。一旦认为经动脉栓塞不安全，并且两条岩下窦都无法进入右侧海绵窦，就直接穿刺到海绵窦成功地填塞了受累的腔隙。3-5 强调了 DynaCT 成像和针引导软件的辅助作用（视频 1）。
