Nakamura Kazuki, Kuge Atsushi, Yamaki Tetsu, Sano Kenshi, Saito Shinjiro, Kondo Rei, Sonoda Yukihiko
Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Yamagata, Japan.
Department of Emergency Medicine, Yamagata City Hospital Saiseikan, Yamagata, Yamagata, Japan.
J Neuroendovasc Ther. 2022;16(10):523-528. doi: 10.5797/jnet.cr.2022-0002. Epub 2022 Jul 22.
We describe a patient treated with transarterial Onyx embolization for a tentorial dural arteriovenous fistula (DAVF) who presented with hemifacial spasm (HFS).
A 56-year-old man suffered from right blepharospasm for 4 years, and the symptom gradually spread to the right side of his face with oculo-oral synkinesis. MRI of the brain revealed abnormal multiple flow voids at the surface of brainstem and cerebellar hemisphere. MRA (time of flight) and spoiled gradient recalled echo-revealed abnormal vessels at the posterior fossa indicated arteriovenous shunting. 3D-MRI fusion images showed that a dilated vein was in contact with the root exit zone (REZ) of the right facial nerve. The right carotid angiography displayed a complex tentorial DAVF on the right side. There were multiple feeding vessels drained to the tentorial sinus at the point where the inferior cerebellar vermian vein met, and severe venous congestion was noted. We diagnosed a tentorial DAVF and thought that this was responsible for the right HFS. We used neuroendovascular treatment for this lesion. After transarterial Onyx embolization, his right HFS diminished. MRI after treatment showed that the vein in contact with the REZ of the right facial nerve had shrank.
We experienced a rare case of HFS associated with a DAVF. Our case supports that transarterial Onyx embolization can treat HFS associated with a tentorial DAVF. It is the first description of successful treatment that could be confirmed through postoperative MRI.
我们描述了一名经动脉用奥尼克斯（Onyx）栓塞治疗天幕硬脑膜动静脉瘘（DAVF）并出现半面痉挛（HFS）的患者。
一名56岁男性，右侧眼睑痉挛4年，症状逐渐蔓延至右侧面部并伴有动眼 - 口部联合运动。脑部MRI显示脑干和小脑半球表面有多个异常血流空洞。磁共振血管造影（飞行时间法）和扰相梯度回波序列显示后颅窝有异常血管，提示动静脉分流。三维MRI融合图像显示一条扩张的静脉与右侧面神经的神经根出脑区（REZ）接触。右侧颈动脉血管造影显示右侧有一个复杂的天幕DAVF。有多个供血血管引流至小脑蚓部下静脉汇合处的天幕窦，且可见严重的静脉淤血。我们诊断为天幕DAVF，并认为这是导致右侧HFS的原因。我们对该病变采用了神经血管内治疗。经动脉奥尼克斯栓塞术后，他的右侧HFS减轻。治疗后的MRI显示与右侧面神经REZ接触的静脉已经缩小。
我们遇到了一例罕见的与DAVF相关的HFS病例。我们的病例支持经动脉奥尼克斯栓塞可以治疗与天幕DAVF相关的HFS。这是首次通过术后MRI证实成功治疗的描述。
