Choi Hye Won, Jee Tae Keun, Lee Young Woon, Yeon Je Young, Jeon Pyoung, Kim Jong-Soo, Kim Keon Ha
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Neurosurgery, Dongsuwon General Hospital, Suwon, Korea.
J Korean Neurosurg Soc. 2025 Jul;68(4):415-424. doi: 10.3340/jkns.2024.0168. Epub 2025 Apr 28.
This retrospective study evaluates our experience with transarterial embolization (TAE) of dural arteriovenous fistulas (dAVFs) using the ascending pharyngeal artery (APA), considering its selective application as a route for the treatment.
We performed a retrospective analysis of medical records and radiologic data of all patients who underwent TAE through the APA at our institution from January 2009 to April 2021.
We identified 305 patients with cranial dAVFs treated endovascularly at our center, focusing on 11 cases (3.6%) where the APA was used for Onyx embolization. Of the 11 dAVFs, five (45%) were completely occluded, three (27%) showed residual shunt but cortical venous reflux disappeared, and three (27%) showed decreased shunt flow but persistent cortical venous reflux. Cranial nerve palsy occurred in two of the cases in which TAE was performed with the jugular branch and hypoglossal branch of the neuromeningeal trunk, which partially improved over 4 to 6 months. No new instances of infarction or hemorrhage were noted on subsequent magnetic resonance angiography.
Transarterial Onyx embolization through the APA could be a limited option reserved for cases where embolization using other branches is challenging or carries a high risk of incomplete treatment. While embolizing through the jugular and hypoglossal branches of the APA neuromeningeal trunk requires greater caution, selecting the posterior meningeal artery or pharyngeal trunk appears to be associated with a lower risk. A comprehensive understanding of angiography is crucial for identifying cases suitable for this approach and those with a higher risk of complications.
本回顾性研究评估了我们使用咽升动脉（APA）对硬脑膜动静脉瘘（dAVF）进行经动脉栓塞（TAE）的经验，并考虑将其作为一种选择性治疗途径的应用情况。
我们对2009年1月至2021年4月在本机构通过APA进行TAE的所有患者的病历和放射学数据进行了回顾性分析。
我们确定了在我们中心接受血管内治疗的305例颅内dAVF患者，重点关注了11例（3.6%）使用APA进行Onyx栓塞的病例。在这11例dAVF中，5例（45%）完全闭塞，3例（27%）显示有残余分流但皮质静脉反流消失，3例（27%）显示分流流量减少但皮质静脉反流持续存在。在其中2例通过神经脑膜干的颈支和舌下支进行TAE的病例中出现了脑神经麻痹，在4至6个月内部分改善。后续磁共振血管造影未发现新的梗死或出血病例。
通过APA进行经动脉Onyx栓塞可能是一种有限的选择，仅适用于使用其他分支进行栓塞具有挑战性或存在高不完全治疗风险的病例。虽然通过APA神经脑膜干的颈支和舌下支进行栓塞需要更加谨慎，但选择脑膜后动脉或咽支似乎风险较低。对血管造影的全面理解对于识别适合这种方法的病例和并发症风险较高的病例至关重要。
