Nishihori Masahiro, Izumi Takashi, Tsukada Tetsuya, Kato Yutaka, Uda Kenji, Yokoyama Kinya, Araki Yoshio, Saito Ryuta
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Radiological Technology, Nagoya University Hospital, Nagoya, Aichi, Japan.
J Neuroendovasc Ther. 2022;16(3):163-169. doi: 10.5797/jnet.cr.2021-0029. Epub 2021 Aug 14.
Superior petrosal sinus dural arteriovenous fistula (SPS-DAVF) is a rare subtype of intracranial DAVF that sometimes leads to hemorrhagic symptoms following deep venous drainage. Here we report the case of SPS-DAVF with retrograde venous reflux to the cerebellar vein. Preoperative contrast-enhanced MRI was a decisive factor in a safe and effective treatment.
A 37-year-old woman was referred to our hospital with abnormal MRI findings, which was performed when she had a mild headache during her check-up. DSA revealed left-sided SPS-DAVF, which was diagnosed as Cognard type IIb. Both CTA and DSA could not detect the whole SPS but only the shunt pouch. Using contrast-enhanced MRI, we were able to visualize the presence of the SPS and its continuity within the shunt pouch. 3D-T1 turbo spin echo (SPACE) showed a low-intensity area in the SPS, which was not seen in the 3D-T1 fast field echo (FFE). During the procedure, there was a point where it was difficult to advance the microcatheter, which coincided with the low-intensity area. We achieved effective transvenous embolization from the occluded venous access by devising a surgical technique.
In addition to the contrast-enhanced 3D-T1 FFE, 3D-T1 SPACE might provide beneficial information for endovascular therapy in the evaluation of venous sinuses, which could not be detected by standard examinations.
岩上窦硬脑膜动静脉瘘（SPS - DAVF）是颅内硬脑膜动静脉瘘的一种罕见亚型，有时在深部静脉引流后会导致出血症状。在此我们报告一例伴有小脑静脉逆行性静脉反流的SPS - DAVF病例。术前增强磁共振成像（MRI）是安全有效治疗的决定性因素。
一名37岁女性因MRI检查异常被转诊至我院，该检查是在她体检时出现轻度头痛时进行的。数字减影血管造影（DSA）显示左侧SPS - DAVF，诊断为Cognard IIb型。CT血管造影（CTA）和DSA均无法检测到整个岩上窦，仅能检测到分流囊袋。通过增强MRI，我们能够观察到岩上窦的存在及其在分流囊袋内的连续性。三维T1加权快速自旋回波序列（3D - T1 SPACE）显示岩上窦内有低信号区，而三维T1加权快速场回波序列（3D - T1 FFE）未显示。在手术过程中，有一个微导管难以推进的点，这与低信号区相吻合。我们通过设计一种手术技术，从闭塞的静脉通路实现了有效的经静脉栓塞。
除了增强三维T1加权快速场回波序列外，三维T1加权快速自旋回波序列可能为评估静脉窦的血管内治疗提供有益信息，而这些信息是标准检查无法检测到的。
