Akioka Naoki, Kuwayama Naoya, Kuroda Satoshi
Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Toyama, Japan.
Department of Neurosurgery, Toyama Red Cross Hospital, Toyama, Toyama, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.ra.2023-0034. Epub 2023 Dec 23.
The sphenoid wing dural arteriovenous fistulas (DAVFs) are clinically rare. They often present as non-sinus-type arteriovenous fistulas (AVFs) and may be associated with focal neurological deficits, intracranial venous hypertension, and intracranial hemorrhage. These cases are classified as lesser or greater sphenoid wing lesions. We searched the PubMed databases for studies evaluating the clinical presentation, surgical treatment, and endovascular treatment of these lesions and analyzed 37 cases from 22 papers. A total of 17 cases had lesser sphenoid wing AVFs, and the localization of the shunts could be divided into the sinus of the lesser sphenoid wing (SLSW) or the superficial middle cerebral vein (SMCV). Most SLSW AVFs drained into the cavernous sinus, but two cases drained directly into the deep middle cerebral vein via a bridging vein. All cases with shunts directly into the SMCV had reflux into the SMCV with varices. A total of 20 cases had shunts in the greater sphenoid wing, and the localization of the shunts varied, with shunt localization, and venous return morphology dependent on variations in middle fossa venous return. Most cases had shunts in the sphenobasal vein near the foramen ovale. However, some cases had shunts in the superior ophthalmic vein, sphenopetrosal vein, and laterocavernous sinus. Many were associated with cortical venous reflux. These lesions have been treated by surgical ligation of the drainage vein and transarterial or transvenous embolization. Recently, embolization has become the standard treatment for DAVFs due to advances in endovascular techniques. This paper reviewed and discussed the angioarchitecture, clinical presentation, and treatment of these lesions to clarify the characteristics of sphenoid wing DAVFs.
蝶骨嵴硬脑膜动静脉瘘（DAVFs）在临床上较为罕见。它们常表现为非窦型动静脉瘘（AVFs），可能伴有局灶性神经功能缺损、颅内静脉高压和颅内出血。这些病例分为蝶骨嵴较小或较大病变。我们在PubMed数据库中检索了评估这些病变临床表现、手术治疗和血管内治疗的研究，并分析了22篇论文中的37例病例。共有17例为蝶骨嵴较小的AVFs，分流部位可分为蝶骨嵴较小的窦（SLSW）或大脑中浅静脉（SMCV）。大多数SLSW AVFs引流至海绵窦，但有两例通过桥静脉直接引流至大脑中深静脉。所有直接分流至SMCV的病例均伴有静脉曲张反流至SMCV。共有20例在蝶骨嵴较大处有分流，分流部位各异，分流部位及静脉回流形态取决于中颅窝静脉回流的变异。大多数病例在卵圆孔附近的蝶基底静脉有分流。然而，一些病例在上眼静脉、蝶岩静脉和海绵窦外侧有分流。许多与皮质静脉反流有关。这些病变已通过手术结扎引流静脉以及经动脉或经静脉栓塞进行治疗。近年来，由于血管内技术的进步，栓塞已成为DAVFs的标准治疗方法。本文回顾并讨论了这些病变的血管构筑、临床表现和治疗，以阐明蝶骨嵴DAVFs的特征。
