Tsutsui Taishi, Misaki Kouichi, Yoshikawa Akifumi, Nogami Kenshu, Nambu Iku, Kamide Tomoya, Muramatsu Naoki, Nakada Mitsutoshi
Department of Neurosurgery, Kanazawa University, Kanazawa, Japan.
Department of Neurosurgery, Kanazawa Medical University, Uchinada, Japan.
Surg Neurol Int. 2023 Feb 3;14:44. doi: 10.25259/SNI_1087_2022. eCollection 2023.
Dural arteriovenous fistulas (dAVFs) occurring near the hypoglossal canal are rare. Detailed evaluation of vascular structures can identify shunt pouches at the jugular tubercle venous complex (JTVC) in the bone near the hypoglossal canal. Although the JTVC has several venous connections, including the hypoglossal canal, there have been no reports of transvenous embolization (TVE) of a dAVF at the JTVC using an approach route other than the hypoglossal canal. This report describes the first case of complete occlusion with targeted TVE using an alternative approach route in a 70-year-old woman presenting with tinnitus diagnosed with dAVF at the JTVC.
The patient had no history of head trauma or other preexisting conditions. Magnetic resonance imaging (MRI) showed no abnormal findings in the brain parenchyma. Magnetic resonance angiography (MRA) revealed a dAVF near the ACC. The shunt pouch was located in the JTVC, near the left hypoglossal canal, with feeders from the bilateral ascending pharyngeal arteries and occipital arteries, left meningohypophyseal trunk, and odontoid arch of the left vertebral artery. TVE was performed near the shunt pouch. Localized packing of the shunt point was achieved. The patient's tinnitus improved. Postoperative MRI showed disappearance of the shunt without any complications. No recurrence was observed on MRA 6 months after treatment.
Our results suggest targeted TVE is an effective treatment for dAVFs at the JTVC.
发生于舌下神经管附近的硬脑膜动静脉瘘（dAVF）较为罕见。对血管结构进行详细评估可发现舌下神经管附近骨内颈静脉结节静脉复合体（JTVC）处的分流囊袋。尽管JTVC有包括舌下神经管在内的多处静脉连接，但尚无关于采用舌下神经管以外的入路途径对JTVC处dAVF进行经静脉栓塞（TVE）的报道。本报告描述了首例采用替代入路途径对一名70岁患有耳鸣且被诊断为JTVC处dAVF的女性患者进行靶向TVE并实现完全闭塞的病例。
该患者无头部外伤史或其他既往疾病史。磁共振成像（MRI）显示脑实质无异常发现。磁共振血管造影（MRA）显示ACC附近存在dAVF。分流囊袋位于左舌下神经管附近的JTVC，供血动脉来自双侧咽升动脉、枕动脉、左脑膜垂体干和左椎动脉齿突支。在分流囊袋附近进行了TVE。实现了分流点的局部填塞。患者的耳鸣症状改善。术后MRI显示分流消失且无任何并发症。治疗后6个月的MRA未观察到复发。
我们的结果表明，靶向TVE是治疗JTVC处dAVF的有效方法。
