Yang Biao, Ren Yeqing, Wu Yongqiang, Zhang Wenju, Sun Yanqi, Guo Xiaolong, Lv Ming, Guo Geng
Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Front Surg. 2023 Jan 6;9:1043340. doi: 10.3389/fsurg.2022.1043340. eCollection 2022.
Dural arteriovenous fistulas of the hypoglossal canal (HCDAVFs) involving the anterior condylar confluence (ACC) and anterior condylar vein (ACV) are infrequent. Although transvenous embolization through the internal jugular vein (IJV) is the preferred treatment option for type I and II fistulas, it can be difficult if the IJV is unavailable. Here we report a rare case of HCDAVF in which the most common transvenous embolization access via IJV was not available. The patient underwent transarterial and transvenous onyx embolization. Transarterial embolization (TAE) aimed at controlling the arterial inflow and subsequently TVE was performed via the external jugular vein (EJV), the facial vein, the ophthalmic vein, the cavernous sinus, ACC, and ultimately to the fistula pouch. Complete obliteration of the HCDAVF was achieved without complications. We suggest that transvenous embolization (TVE) via the EJV and the facial vein can be effective in cases where trans-IJV is not possible.
累及髁前汇合处（ACC）和髁前静脉（ACV）的舌下神经管硬脑膜动静脉瘘（HCDAVF）较为罕见。尽管经颈内静脉（IJV）进行经静脉栓塞是I型和II型瘘的首选治疗方法，但如果无法使用颈内静脉则可能会遇到困难。在此，我们报告1例罕见的HCDAVF病例，其中无法采用最常用的经颈内静脉经静脉栓塞入路。该患者接受了经动脉和经静脉的Onyx栓塞治疗。经动脉栓塞（TAE）旨在控制动脉血流，随后经颈外静脉（EJV）、面静脉、眼静脉、海绵窦、ACC并最终至瘘管囊袋进行经静脉栓塞（TVE）。HCDAVF完全闭塞，且无并发症发生。我们认为，在无法行经颈内静脉途径时，经颈外静脉和面静脉进行经静脉栓塞可能有效。
