Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, 13867Kitano Hospital, Japan.
Neuroradiol J. 2023 Apr;36(2):236-240. doi: 10.1177/19714009221128659. Epub 2022 Sep 20.
Accurate microcatheter placement for anterior condylar arteriovenous fistula (AVF) enables selective transvenous embolization (TVE) and helps to avoid hypoglossal nerve palsy. Anterior condylar AVF has a shunted pouch within the condylar vascular and osseous structures. Detailed anatomical comprehension of the shunted pouch is essential, in addition, we believe that it is important to have a strategy for where in the shunted pouch to start filling with coils. Specifically, we consider that it is important to structurally understand the more upstream location (arterial side) within the shunted pouch (called "), guide the microcatheter there, and embolize from that site. Although several studies have discussed the usefulness of intraoperative cone-beam computed tomography (CBCT) for treating anterior condylar AVF, there are no studies which have mentioned the importance of microcatheter position before coil embolization in selective TVE as in this study. Intraoperative localization of the shunted pouch entry zone is often difficult. Herein, the authors report that cone-beam computed tomography (CBCT) can assist accurate microcatheter tip placement at the shunted pouch entry zone before staring embolization. This is the novel application of intraoperative CBCT to treat anterior condylar AVF successfully treated with precise and selective TVE.
准确地将微导管放置在前髁突动静脉瘘（AVF）中，可进行选择性经静脉栓塞（TVE），并有助于避免舌下神经麻痹。前髁突 AVF 在髁突血管和骨骼结构内有一个分流囊。除了详细的解剖学理解分流囊之外，我们还认为制定在分流囊中何处开始填充线圈的策略很重要。具体来说，我们认为重要的是从结构上理解分流囊内的上游位置（动脉侧）（称为“），将微导管引导至该位置，并从该部位进行栓塞。尽管已有几项研究讨论了术中锥形束 CT（CBCT）在治疗前髁突 AVF 中的有用性，但没有研究像本研究那样提到在选择性 TVE 中进行线圈栓塞前微导管位置的重要性。术中定位分流囊入口区通常很困难。在此，作者报告说，锥形束 CT（CBCT）可以在开始栓塞之前，辅助准确地将微导管尖端放置在分流囊入口区。这是术中 CBCT 成功应用于治疗前髁突 AVF 的新方法，采用精确和选择性 TVE 治疗。
