Oshita Jumpei, Sakamoto Shigeyuki, Okazaki Takahito, Kuwabara Masashi, Kurisu Kaoru
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan.
J Neuroendovasc Ther. 2020;14(9):373-380. doi: 10.5797/jnet.oa.2020-0038. Epub 2020 Jul 2.
Transvenous embolization (TVE) is an effective treatment for cavernous sinus dural arteriovenous fistulas (CS-DAVFs). The facial vein (FV) can be used as an access route for TVE when a trans-inferior petrosal sinus (IPS) approach is difficult. We evaluated the usefulness of combining ultrasonography (US) with computed tomography angiography (CTA) for confirming that the FV is a suitable access route for treating CS-DAVFs.
Trans-FV TVE was planned for five CS-DAVF patients in whom the shunt point was located in the posterior compartment of the CS and anterior venous drainage predominantly occurred via the superior ophthalmic vein (SOV). The anterior drainage route was examined with CTA and US. We reviewed the relationships between preoperative CTA/US findings and the accessibility of CS-DAVFs via the FV.
The periorbital and perimandibular drainage pathways were clearly more visible on US than on CTA, and the cervical and thoracic drainage pathways were more visible on CTA than on digital subtraction angiography (DSA). CS-DAVFs were accessible via the FV when (1) the entire drainage pathway could be confirmed on CTA and US, (2) the periorbital and perimandibular pathways were unclear on CTA, but could be confirmed on US, or (3) the FV pathway drained into the internal jugular vein (IJV) or external jugular vein (EJV). On the other hand, TVE was challenging to perform via the FV when (1) the periorbital pathway was unclear on CTA and US, (2) the FV pathway drained into the brachiocephalic vein, or (3) the SOV thrombosed intraoperatively. In all five patients, TVE for CS-DAVFs performed via the FV or IPS was successful.
CTA and US are useful for confirming the anterior access route for trans-FV TVE for CS-DAVFs and predicting the feasibility of such treatment. Our findings suggest that CS-DAVFs can be accessed via the FV if the periorbital drainage pathway can be confirmed on US, even if the pathway is unclear on CTA.
经静脉栓塞术（TVE）是治疗海绵窦硬脑膜动静脉瘘（CS-DAVFs）的有效方法。当经岩下窦（IPS）入路困难时，面静脉（FV）可作为TVE的入路途径。我们评估了超声检查（US）与计算机断层血管造影（CTA）相结合对于确认FV是治疗CS-DAVFs合适入路途径的有效性。
计划对5例CS-DAVF患者行经FV TVE，这些患者的分流点位于海绵窦后份，主要经眼上静脉（SOV）进行前位静脉引流。采用CTA和US检查前位引流途径。我们回顾了术前CTA/US检查结果与经FV治疗CS-DAVFs的可达性之间的关系。
眶周和下颌周引流途径在US上比在CTA上更清晰可见，而颈部和胸部引流途径在CTA上比在数字减影血管造影（DSA）上更清晰可见。当出现以下情况时，CS-DAVFs可经FV进行治疗：（1）在CTA和US上均可确认整个引流途径；（2）眶周和下颌周途径在CTA上不清晰，但在US上可确认；或（3）FV途径汇入颈内静脉（IJV）或颈外静脉（EJV）。另一方面，当出现以下情况时，经FV进行TVE具有挑战性：（1）眶周途径在CTA和US上均不清晰；（2）FV途径汇入头臂静脉；或（3）术中SOV血栓形成。在所有这5例患者中，经FV或IPS进行的CS-DAVFs TVE均成功。
CTA和US对于确认经FV TVE治疗CS-DAVFs的前位入路途径及预测该治疗的可行性很有用。我们的研究结果表明，即使在CTA上该途径不清晰，但如果在US上可确认眶周引流途径，CS-DAVFs也可经FV进行治疗。
