Ogura Ryosuke, Hasegawa Hitoshi, Kumagai Shunsuke, Takahashi Haruhiko, Fujiwara Hidemoto, Yoshimura Junichi, Fujii Yukihiko
Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Niigata, Japan.
Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan.
J Neuroendovasc Ther. 2020;14(3):112-117. doi: 10.5797/jnet.tn.2019-0053. Epub 2020 Jan 14.
For curative Onyx embolization of dural arteriovenous fistulas (dAVF) with multiple feeders, it is essential to select the optimal target artery as well as to control the blood flow at the fistula point. We report a case of tentorial dAVF (TdAVF) treated by Onyx embolization under flow control using balloon catheters.
A 66-year-old male was admitted to our hospital for treatment of TdAVF detected incidentally by MRI, which revealed a dilated and tortuous vein around the cerebellum. Cerebral angiography demonstrated a TdAVF, fed mainly by bilateral middle meningeal arteries (MMA) and bilateral occipital arteries (OA), with the fistula point at the torcular and venous drainage to the two superior vermian veins (SVVs). Onyx 18 was injected from the low-flow feeder of the MMA under flow control by occluding the high-flow feeder of the OA using balloon catheters, obliterating the arteriovenous shunt.
In treatment of TdAVF involving low- and high-flow feeders, Onyx embolization via the low-flow feeder with temporary balloon occlusion of other high-flow feeders is a useful method. This technique makes it easier for Onyx to penetrate the fistula point.
对于采用Onyx栓塞术治疗具有多个供血动脉的硬脑膜动静脉瘘（dAVF），选择最佳靶动脉以及控制瘘口处的血流至关重要。我们报告一例经天幕硬脑膜动静脉瘘（TdAVF）患者，采用球囊导管控制血流，使用Onyx进行栓塞治疗。
一名66岁男性因MRI偶然发现TdAVF入院治疗，MRI显示小脑周围有一条扩张且迂曲的静脉。脑血管造影显示为TdAVF，主要由双侧脑膜中动脉（MMA）和双侧枕动脉（OA）供血，瘘口位于窦汇，静脉引流至两条小脑上蚓静脉（SVV）。在使用球囊导管闭塞OA的高流量供血动脉以控制血流的情况下，从MMA低流量供血动脉注入Onyx 18，闭塞动静脉分流。
在治疗涉及低流量和高流量供血动脉的TdAVF时，通过低流量供血动脉进行Onyx栓塞并临时用球囊闭塞其他高流量供血动脉是一种有效的方法。该技术使Onyx更容易穿透瘘口。
