Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, The first affiliated Hospital of Hainan Medical University, Haikou, Hainan 570100, China.
Clin Neurol Neurosurg. 2024 Oct;245:108515. doi: 10.1016/j.clineuro.2024.108515. Epub 2024 Aug 17.
Cognard type IIa+b dural arteriovenous fistulas (DAVFs) in the lateral sinuses are often complicated with venous sinus obstruction and accompanied by clinical symptoms and a risk of hemorrhage. The purpose of this study was to assess venous sinus stenting as a viable alternative treatment in complex lateral sinus DAVFs and examine its efficacy and safety.
We retrospectively examined patients diagnosed with type IIa+b DAVF in the transverse or sigmoid sinus with associated venous sinus occlusion who were treated via stent placement between April 2017 and June 2019.
Six patients were included in this study. Three patients had DAVFs in both the transverse and sigmoid sinuses, two in the transverse sinus and confluence of sinuses, and one in the transverse sinus. The most common symptoms were headache, dizziness, and limb weakness. At the last follow-up, three patients had significant improvement, and three were asymptomatic. Angiograms performed immediately after the surgery showed restoration of the anterograde venous drainage in all patients. According to the follow-up angiography results, two DAVFs were completely obliterated, and four remained as stable type I DAVFs. Most patients had satisfactory venous sinus drainage, except one who had in-stent stenosis.
Stent placement can restore sinus patency, improve clinical symptoms, and decrease intracranial hemorrhage risk. This approach may be an effective option for treating type IIa+b lateral DAVFs complicated by sinus occlusion.
外侧窦的 Cognard IIa+b 型硬脑膜动静脉瘘（DAVF）常伴有静脉窦阻塞，并伴有临床症状和出血风险。本研究旨在评估静脉窦支架置入作为复杂外侧窦 DAVF 的一种可行的替代治疗方法，并研究其疗效和安全性。
我们回顾性分析了 2017 年 4 月至 2019 年 6 月期间采用支架置入治疗的横窦或乙状窦合并静脉窦阻塞的 IIa+b 型 DAVF 患者。
本研究纳入 6 例患者。3 例患者横窦和乙状窦均有 DAVF，2 例患者横窦和窦汇处有 DAVF，1 例患者横窦有 DAVF。最常见的症状是头痛、头晕和肢体无力。末次随访时，3 例患者症状明显改善，3 例患者无症状。术后即刻行血管造影显示所有患者均恢复顺行静脉引流。根据随访血管造影结果，2 例 DAVF 完全闭塞，4 例仍为稳定型 I 型 DAVF。除 1 例支架内狭窄外，大多数患者的静脉窦引流均满意。
支架置入可恢复窦腔通畅，改善临床症状，降低颅内出血风险。对于伴有窦腔阻塞的 IIa+b 型外侧 DAVF，该方法可能是一种有效的治疗选择。
