Department of Radiology, 25443Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
Department of Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada.
Interv Neuroradiol. 2022 Dec;28(6):629-633. doi: 10.1177/15910199211057705. Epub 2021 Nov 13.
Cerebello-pontine AVMs (CPAVMs) and petrous apex dural arteriovenous fistulae (DAVFs) are rare and sometimes difficult to distinguish. We report a fatal hemorrhagic complication after coil embolization of the petrosal vein draining a trigeminal AVM misdiagnosed as a DAVF.
A 73-year-old woman with a petrous apex arteriovenous shunt with dual dural and pial arterial supply presented with posterior fossa hemorrhage. The draining petrosal vein was catheterized and coiled via the superior petrosal sinus. Two episodes of contrast extravasation occurred during coiling, but the lesion was completely occluded at the end of the procedure. The patient developed a fatal posterior fossa hemorrhage in the recovery room. Microscopic pathology revealed numerous dilated vessels within the trigeminal nerve.
CPAVMs and DAVFs with pial drainage should be distinguished pre-operatively. Occlusion of a pial vein (as opposed to a sinus) in the treatment of an arteriovenous shunt carries hemorrhagic risk if a liquid embolic agent is not used to completely occlude all pathological vessels.
桥脑小脑角动静脉畸形（CPAVMs）和岩尖硬脑膜动静脉瘘（DAVFs）较为罕见，有时难以鉴别。我们报告了一例因三叉神经动静脉畸形引流岩静脉的静脉内栓塞术，误诊为 DAVF 后出现致命性出血并发症。
一名 73 岁女性，因岩尖动静脉分流伴双重硬脑膜和软脑膜动脉供血而就诊，出现后颅窝出血。通过岩上窦对引流岩静脉进行了导管插入和线圈栓塞。在栓塞过程中发生了两次造影剂外渗，但在手术结束时病变完全闭塞。患者在恢复室出现致命性后颅窝出血。显微镜下病理显示三叉神经内有许多扩张的血管。
CPAVMs 和具有软脑膜引流的 DAVFs 应在术前进行鉴别。如果不使用液体栓塞剂完全闭塞所有病理性血管，在治疗动静脉分流时闭塞软膜静脉（而非窦）会增加出血风险。
