Shose Hiroyasu, Fujita Atsushi, Hori Tatsuo, Tanabe Daiki, Ikeda Mitsuru, Sasayama Takashi
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Department of Neurosurgery, Yodogawa Christian Hospital, Osaka, Japan.
Surg Neurol Int. 2025 Mar 14;16:89. doi: 10.25259/SNI_1091_2024. eCollection 2025.
Dural arteriovenous fistulas (DAVFs) are abnormal connections between the dural arteries and dural venous sinuses or subarachnoid veins. A rare subtype of DAVF is tentorial DAVF (TDAVF), which is highly aggressive and often exhibits direct retrograde leptomeningeal drainage, increasing the risks of hemorrhage and venous ischemia. Transarterial embolization (TAE) using Onyx has become the preferred treatment method. In Onyx-based TAE, a long embolic material segment should be established within the draining vein past the shunt point. Here, we report a case of a patient with TDAVF who was successfully managed with preservation of the normal deep venous system through a combination of transarterial and transvenous embolization (TVE).
A 56-year-old man was referred to our hospital following an abnormal brain imaging finding during a routine checkup. Angiography identified a TDAVF draining into the vein of Galen, categorized as Cognard type III. During Onyx injections, excessive penetration of the draining vein may lead to deep venous system occlusion, potentially causing severe complications. To mitigate this risk, we performed transarterial Onyx injection with TVE using coils, achieving complete occlusion without inducing deep venous infarction.
The combination of TVE using coils and Onyx TAE is an effective approach for managing TDAVF, particularly in cases where the distance from the shunt point to the normal venous return is brief, the shunt flow is high, or crucial veins, such as deep cerebral veins, are involved.
硬脑膜动静脉瘘（DAVF）是硬脑膜动脉与硬脑膜静脉窦或蛛网膜下腔静脉之间的异常连接。DAVF的一种罕见亚型是小脑幕DAVF（TDAVF），它具有高度侵袭性，常表现为直接逆行软脑膜引流，增加了出血和静脉缺血的风险。使用Onyx进行经动脉栓塞（TAE）已成为首选的治疗方法。在基于Onyx的TAE中，应在引流静脉内分流点后方建立一段较长的栓塞材料段。在此，我们报告一例TDAVF患者，通过经动脉和经静脉栓塞（TVE）联合治疗成功保留了正常的深静脉系统。
一名56岁男性在常规体检中脑部影像学检查发现异常后转诊至我院。血管造影显示TDAVF引流至大脑大静脉，分类为Cognard III型。在注射Onyx时，引流静脉过度穿透可能导致深静脉系统闭塞，潜在地引起严重并发症。为降低此风险，我们使用弹簧圈进行TVE并同时经动脉注射Onyx，实现了完全闭塞且未诱发深静脉梗死。
使用弹簧圈进行TVE与Onyx TAE联合是治疗TDAVF的有效方法，特别是在分流点至正常静脉回流距离短、分流流量高或涉及关键静脉（如大脑深静脉）的情况下。
