Tanaka Yuko, Yoshiyama Tomomi, Nishiyama Akira, Umesaki Arisa, Nakajou Takato, Matsumoto Hiroaki, Terada Tomoaki
Department of Neurosurgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
J Neuroendovasc Ther. 2020;14(6):231-237. doi: 10.5797/jnet.cr.2019-0021. Epub 2020 Apr 8.
We report a case of anterior cranial fossa dural arteriovenous fistula (dAVF) in which ocular movement was impaired after Onyx embolization from the ophthalmic artery (OphA).
A 76-year-old male was admitted to our hospital for treatment of an incidentally found anterior cranial fossa dAVF. Onyx was injected from the right anterior ethmoidal artery (AEA) to close the shunt. Onyx refluxed to the third portion of the OphA to make a plug, but was unable to reach the venous side beyond the shunt; therefore, a small shunt remained. Although his visual acuity and field were normal, vertical diplopia developed after embolization and disappeared 1 month later. Diplopia worsened when the patient tilted his head to the right. Neuro-ophthalmological examination confirmed right superior oblique muscle impairment. The cause of diplopia was considered to be ischemic injury of the superior oblique muscle associated with embolization of the AEA, which provides nutrients to the superior oblique muscle and trochlear nerve.
Embolization from the OphA beyond the third portion may cause external ophthalmoplegia, although it may heal spontaneously.
我们报告一例前颅窝硬脑膜动静脉瘘（dAVF），该患者在经眼动脉（OphA）进行Onyx栓塞后出现眼球运动障碍。
一名76岁男性因偶然发现的前颅窝dAVF入院治疗。从右侧筛前动脉（AEA）注入Onyx以封闭分流。Onyx反流至OphA的第三段形成栓塞，但未能到达分流处远端的静脉侧；因此，仍残留一小分流。尽管其视力和视野正常，但栓塞后出现垂直性复视，1个月后消失。当患者头部向右侧倾斜时复视加重。神经眼科检查证实右上斜肌受损。复视的原因被认为是与为右上斜肌和滑车神经提供营养的AEA栓塞相关的上斜肌缺血性损伤。
OphA第三段以外的栓塞可能导致眼球外肌麻痹，尽管其可能自行恢复。
