Chen Xi, Ge Liang, Wan Hailin, Huang Lei, Jiang Yeqing, Lu Gang, Wang Jing, Zhang Xiaolong
Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
J Interv Med. 2022 Aug 5;6(1):41-45. doi: 10.1016/j.jimed.2022.07.003. eCollection 2023 Feb.
A dural arteriovenous fistula (DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization (TAE), transvenous embolization (TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging (MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.
硬脑膜动静脉瘘（DAVF）是一种连接颅内硬脑膜内动脉和静脉系统的异常连接。颅底导静脉型DAVF引流至海绵窦和眼静脉，与海绵窦型DAVF相似。术前精确确定DAVF的位置是进行适当治疗的前提。治疗选择包括显微手术切断、血管内动脉栓塞术（TAE）、经静脉栓塞术（TVE）或联合应用上述方法。由于动脉入路存在危险吻合导致颅神经病变的风险，TVE是治疗DAVF越来越常用的方法，也是颅底部位的首选方法。多模态磁共振成像（MRI）可为TVE提供解剖和血流动力学信息。治疗靶点必须在导静脉中精确栓塞，这需要多模态MRI的引导。在此，我们报告一例罕见的利用多模态MRI辅助成功进行颅底导静脉型DAVF经静脉栓塞术的病例。在8个月的随访血管造影中观察到，瘘消失，翼状静脉丛引流改善，岩下窦再通。外展功能受限导致的复视症状和体征消失。通过多模态MRI进行详细的解剖和血流动力学评估是指导成功诊断和治疗的关键。
