Hendriks Eef J, Lynch Jeremy, Swaminathan Saravana Kumar, Nicholson Patrick, Agid Ronit, Radovanovic Ivan, Pereira Vitor M, terBrugge Karel, Krings Timo
Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
J Neurointerv Surg. 2022 Jun;14(6):605-610. doi: 10.1136/neurintsurg-2021-017652. Epub 2021 Jun 3.
Intracranial dural arteriovenous fistulas (DAVFs) draining into an isolated sinus segment constitute a specific entity within the spectrum of cranial dural AV shunts, with under-reporting of their optimal treatment.
To describe the multimodal treatment approach to isolated sinus DAVFs in a large single-center cohort.
Retrospective analysis of adult patients with an isolated sinus DAVF treated at our institution between 2004 and 2020 was performed. Cases were analyzed for demographics, clinical presentation, angiographic findings, treatment techniques, angiographic and clinical outcomes, and complications.
Of 317 patients with DAVFs, 20 (6.3%) with an isolated sinus DAVF underwent treatment. Transarterial embolization was performed through the middle meningeal artery in 9 of 12 procedures, with a success rate of 66.7%. Transarterial glue embolization proved successful in two of five procedures (40%) and Onyx in six of seven procedures (85.7%). Transvenous embolization (TVE) with navigation via the occlusion into the isolated sinus was successful in seven out of nine procedures (77.8%). All three open TVE and one pure open surgical procedure gained complete closure of the fistula. There were two major complications. Complete occlusion of the fistula was eventually obtained in all cases (100%).
Isolated sinus DAVFs are always aggressive and require a multimodal approach to guarantee closure of the shunt. Transarterial treatment with Onyx achieves good results. Transvenous treatment appears equally successful, navigating into the occluded segment across the occlusion or via burr hole as backup.
引流至孤立静脉窦段的颅内硬脑膜动静脉瘘（DAVF）在颅硬脑膜动静脉分流范围内构成一种特殊类型，其最佳治疗方法的报道较少。
描述在一个大型单中心队列中对孤立静脉窦DAVF的多模式治疗方法。
对2004年至2020年在本机构接受治疗的成年孤立静脉窦DAVF患者进行回顾性分析。分析病例的人口统计学、临床表现、血管造影结果、治疗技术、血管造影和临床结果以及并发症。
在317例DAVF患者中，20例（6.3%）为孤立静脉窦DAVF并接受了治疗。12例手术中有9例通过脑膜中动脉进行经动脉栓塞，成功率为66.7%。经动脉胶水栓塞在5例手术中有2例成功（40%），Onyx在7例手术中有6例成功（85.7%）。通过闭塞进入孤立静脉窦的导航进行经静脉栓塞（TVE）在9例手术中有7例成功（77.8%）。所有3例开放式TVE和1例单纯开放式手术均实现了瘘口的完全闭合。有2例主要并发症。所有病例最终均实现了瘘口的完全闭塞（100%）。
孤立静脉窦DAVF总是具有侵袭性，需要多模式方法来确保分流的闭合。使用Onyx进行经动脉治疗取得了良好效果。经静脉治疗似乎同样成功，可通过闭塞处进入闭塞段或通过钻孔作为备用方法。
