Inoue Satoshi, Fujita Atsushi, Shinoda Kouji, Yamashita Shunsuke, Lee Te Jin, Kuroda Ryuichi, Urui Seishirou, Kurihara Eiji, Sasayama Takashi
Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan.
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
J Neuroendovasc Ther. 2022;16(4):225-231. doi: 10.5797/jnet.cr.2021-0021. Epub 2021 Sep 3.
Laterocavernous sinus dural arteriovenous fistulas (DAVFs) are rare and not always accessible transvenously due to their angioarchitecture. We report a case of non-sinus-type laterocavernous sinus DAVF treated by endovascular transarterial venous coil embolization.
A 78-year-old woman was admitted to our hospital with loss of consciousness, right hemiparesis, and motor aphasia. CT demonstrated intracerebral hematoma in the left frontal lobe and subarachnoid hemorrhage. On CTA and MRA, a DAVF was found in the left laterocavernous sinus region associated with the accessory meningeal artery (AMA) and draining directly into the superficial middle cerebral vein. The diagnosis was confirmed by DSA, which revealed a DAVF fed by the large and straight AMA and the internal carotid artery's meningohypophyseal trunk. Endovascular transarterial venous coil embolization was performed through the AMA. A microcatheter was advanced beyond the shunt point into the origin of the draining vein, and coils were placed in the venous and arterial sides of the fistula. The fistula was completely occluded, and 15-month follow-up angiography demonstrated stable obliteration of the fistula.
Transarterial venous coil embolization may be a treatment option for non-sinus-type laterocavernous sinus DAVF with a large fistula size and a large and straight feeding artery.
海绵窦外侧硬脑膜动静脉瘘（DAVF）较为罕见，因其血管构筑特点，经静脉途径不一定总能到达。我们报告一例经血管内动脉途径静脉弹簧圈栓塞治疗的非窦型海绵窦外侧DAVF病例。
一名78岁女性因意识丧失、右侧偏瘫和运动性失语入住我院。CT显示左额叶脑内血肿和蛛网膜下腔出血。在CTA和MRA上，发现左侧海绵窦外侧区域有一个DAVF，与脑膜副动脉（AMA）相关，直接引流至大脑中浅静脉。DSA确诊，显示该DAVF由粗大且走行笔直的AMA及颈内动脉脑膜垂体干供血。通过AMA进行血管内动脉途径静脉弹簧圈栓塞。将微导管推进至分流点以外进入引流静脉起始部，在瘘口的静脉侧和动脉侧放置弹簧圈。瘘口完全闭塞，15个月的随访血管造影显示瘘口闭塞稳定。
对于瘘口较大且供血动脉粗大且走行笔直的非窦型海绵窦外侧DAVF，动脉途径静脉弹簧圈栓塞可能是一种治疗选择。
