Ohshima Tomotaka, Yokota Mao, Ogura Koichiro, Koiwai Megumi, Matsuo Naoki, MiYACHI Shigeru
Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
NMC Case Rep J. 2022 Apr 1;9:43-47. doi: 10.2176/jns-nmc.2021-0293. eCollection 2022.
Hemorrhagic isolated dural arteriovenous fistulas (DAVFs) are often challenging to treat. Here, we report a case of the lateral cavernous sinus (CS) DAVF successfully treated by transarterial intravenous coil embolization using a curved multiplanar reconstruction (MPR) image assistance. A 54-year-old man presented with a severe headache and was diagnosed with subarachnoid hemorrhage caused by CSDAVF. Angiography indicated that the fistula was fed by branches of the left external carotid artery and drained into cortical veins. There were multiple shunting points at the left sphenobasal vein accompanied by varicose veins. Using curved MPR images, the left accessory meningeal artery was chosen for the endovascular approach into the affected veins, including ruptured varix. The shunt was completely occluded by detachable coils. When the curved MPR image indicates a developing feeding artery and a large shunting point, transarterial intravenous coil embolization becomes a good treatment option for CSDAVF, which has no venous access.
出血性孤立性硬脑膜动静脉瘘（DAVF）的治疗通常具有挑战性。在此，我们报告一例经动脉静脉弹簧圈栓塞术成功治疗的外侧海绵窦（CS）DAVF病例，该过程借助了曲面多平面重建（MPR）图像辅助。一名54岁男性因严重头痛就诊，被诊断为CSDAVF导致的蛛网膜下腔出血。血管造影显示，瘘由左颈外动脉分支供血，并引流至皮质静脉。左蝶骨基底静脉处有多个分流点，伴有静脉曲张。利用曲面MPR图像，选择左脑膜副动脉进行血管内入路至受累静脉，包括破裂的静脉曲张。分流被可脱卸弹簧圈完全闭塞。当曲面MPR图像显示有发育中的供血动脉和较大分流点时，经动脉静脉弹簧圈栓塞术成为无静脉入路的CSDAVF的良好治疗选择。
