From the Division of Neuroradiology, Joint Department of Medical Imaging and University Medical Imaging Toronto (T.P.K., A.L., T.K.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Department of Neuroradiology (T.P.K.), National Neuroscience Institute, Singapore.
AJNR Am J Neuroradiol. 2024 Aug 9;45(8):1025-1030. doi: 10.3174/ajnr.A8246.
Parasagittal and superior sagittal sinus (SSS) dural arteriovenous fistulas (DAVFs) are often inappropriately classified. We explore the clinical presentations, imaging characteristics, and endovascular treatment strategies of these 2 DAVF subtypes.
Clinical and imaging data of 19 patients with SSS or parasagittal sinus DAVFs who underwent endovascular treatment in our institution between 2017 and 2022 were retrospectively analyzed. The angiographic findings, endovascular treatment strategies, and angiographic outcomes were evaluated and recorded.
Among these 19 patients, 14 had a parasagittal DAVF, 4 had a SSS DAVF, and 1 patient had both parasagittal and SSS DAVF. Only 1 (1/19, 5.26%) patient presented with intracranial hemorrhage. For the parasagittal DAVF group, most of the shunts were located along the middle third of the SSS (12/15, 80%), on the dura in proximity with the junctional zone between the bridging vein and SSS (15/15, 100%), with ipsilateral cortical venous reflux (CVR) (15/15, 100%). For the SSS DAVF group, all 5 patients had shunting zone along the middle third of the SSS, on the sinus or parasinus wall, with bilateral CVR. Transarterial embolization, via the middle meningeal artery as the primary route of access, was the primary treatment approach in 95% of cases (19/20). Reflux of embolization material into the SSS was observed in 1 case (1/5, 20%) of SSS DAVF in which balloon sinus protection was not used during embolization.
Our study found that parasagittal DAVFs have shunting point(s) centered on the junctional zone of the bridging vein and the SSS with ipsilateral CVR, while SSS DAVFs have shunting point(s) centered on the sinus or parasinus wall with bilateral CVR. Transarterial embolization via the middle meningeal artery can be used as the primary treatment strategy in most cases. Balloon sinus protection during embolization is not necessary in cases of parasagittal DAVF with occluded or stenosed connection with the SSS but its use should be considered in cases of SSS DAVF with patent sinus.
矢状窦和上矢状窦（SSS）硬脑膜动静脉瘘（DAVF）常被错误分类。我们探讨了这两种 DAVF 亚型的临床特征、影像学特征和血管内治疗策略。
回顾性分析了 2017 年至 2022 年期间在我院接受血管内治疗的 19 例 SSS 或矢状窦旁窦 DAVF 患者的临床和影像学资料。评估并记录了血管造影表现、血管内治疗策略和血管造影结果。
在这 19 例患者中，14 例为矢状窦旁 DAVF，4 例为 SSS DAVF，1 例同时存在矢状窦和 SSS DAVF。只有 1 例（1/19，5.26%）患者出现颅内出血。对于矢状窦旁 DAVF 组，大多数分流位于 SSS 的中三分之一（12/15，80%），在与桥静脉和 SSS 交界处附近的硬脑膜上（15/15，100%），伴有同侧皮质静脉反流（CVR）（15/15，100%）。对于 SSS DAVF 组，所有 5 例患者的分流区均位于 SSS 的中三分之一，位于窦或窦旁壁，伴有双侧 CVR。经动脉栓塞（transarterial embolization）是最主要的治疗方法，通过脑膜中动脉作为主要入路，在 95%的病例中（19/20）采用这种方法。在 5 例 SSS DAVF 中，有 1 例（1/5，20%）未使用球囊窦保护，栓塞材料反流至 SSS。
我们的研究发现，矢状窦旁 DAVF 的分流点位于桥静脉和 SSS 的交界处，伴有同侧 CVR，而 SSS DAVF 的分流点位于窦或窦旁壁，伴有双侧 CVR。经脑膜中动脉的动脉栓塞可作为大多数情况下的主要治疗策略。对于与 SSS 闭塞或狭窄相连的矢状窦旁 DAVF，栓塞过程中无需使用球囊窦保护，但对于 SSS 通畅的 SSS DAVF，应考虑使用球囊窦保护。
