Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Neurointerv Surg. 2024 Oct 14;16(11):1200-1201. doi: 10.1136/jnis-2023-020530.
Endovascular embolization is the first-line therapy for dural arteriovenous fistulas (dAVFs). Transarterial embolization (TAE) may be limited by poor anatomical access. Transvenous embolization avoids this, but carries a risk of hemorrhage, venous redirection, and neurologic deterioration. Dual-lumen balloon microcatheters like the Scepter Mini (Microvention, Aliso Viejo, CA, USA) provide flow arrest and prevent reflux during TAE with liquid embolic agents (LEAs), but use in the distensible veins may be challenging. In this video, we use a Scepter Mini in a transvenous approach to a Cognard type IV anterior ethmoidal dAVF as a safe alternative to surgery, transvenous pressure cooker, and trans-ophthalmic TAE (video 1). The Scepter Mini was navigated transvenously to the anterior superior sagittal sinus. LEA was injected with excellent penetration to the venous pouch and further penetration into the network of tortuous feeders. No neurologic complications were experienced, and follow-up angiogram 9 months later demonstrated cure of the dAVF. Video 2 describes procedural considerations in transvenous approaches, steps of the procedure, and includes references1-10 which are relevant to this topic. neurintsurg;16/11/1200/V1F1V1Video 1 neurintsurg;16/11/1200/V2F2V2Video 2 .
血管内栓塞是硬脑膜动静脉瘘（dAVF）的一线治疗方法。经动脉栓塞（TAE）可能受到解剖学通路不良的限制。经静脉栓塞避免了这一点，但有出血、静脉改道和神经功能恶化的风险。像 Scepter Mini（Microvention，Aliso Viejo，CA，美国）这样的双腔球囊微导管在使用液体栓塞剂（LEA）进行 TAE 时可提供血流阻断并防止反流，但在可扩张静脉中的使用可能具有挑战性。在这个视频中，我们使用 Scepter Mini 通过经静脉途径治疗 Cognard 四型额前硬脑膜动静脉瘘，作为手术、经静脉高压锅和经眶 TAE 的安全替代方法（视频 1）。Scepter Mini 经静脉导航至前上矢状窦。LEA 注射具有良好的穿透性，可进入静脉囊，并进一步穿透迂曲的供血动脉网络。没有出现神经并发症，9 个月后的随访血管造影显示硬脑膜动静脉瘘已治愈。视频 2 描述了经静脉入路的程序注意事项、手术步骤，并包括与本主题相关的参考文献 1-10。
