Orozco Fernando, Sáenz José, Almeida Valeria, Ospino Jose, De La Rosa Ginna, Almeida Rafael
Interventional Neuroradiology, Centre for Research in Haemodynamics, Vascular and Endovascular Surgery, Neurodynamics, Cartagena de Indias, Colombia.
Faculty of Medicine, Radiology and Diagnostic Imaging, Universidad del Sinú, Cartagena, Colombia.
Radiol Case Rep. 2025 May 12;20(8):3693-3697. doi: 10.1016/j.radcr.2025.04.056. eCollection 2025 Aug.
A 27-year-old male patient presented with a history of long-standing headaches, progressive head circumference growth, and a ventriculoperitoneal shunt valve placement in 2018. He was referred for consultation and underwent endovascular neurosurgery in 2019 due to MRI findings suggestive of a cerebral arteriovenous malformation. A neurosurgical board was convened to discuss findings from cerebral panangiography and endovascular treatment options. Cerebral panangiography revealed a Cognard type IV dural arteriovenous fistula, leading to the recommendation of endovascular treatment with Phil embolizing liquid material and a triaxial balloon to reduce venous hypertension. Catheterization was performed through a posterior branch of the right meningeal artery directly afferent to the fistula. A second intervention was performed 6 months later, again utilizing endovascular therapy with Phil embolizing liquid material and balloon via the right femoral artery. The intervention revealed a remnant of the dural arteriovenous fistula with a venous aneurysm in the right sinus. Over a period of several years, 3 additional interventions were performed at intervals of approximately 7 months, achieving partial occlusion. During the fifth intervention, the patient exhibited neurological deterioration, prompting further imaging studies to assess thrombosis of the longitudinal sinus. Endovascular treatment with embolizing liquid material and corticosteroid therapy was administered.
一名27岁男性患者，有长期头痛病史，头围进行性增大，2018年行脑室腹腔分流阀置入术。他因MRI检查结果提示脑动静脉畸形而于2019年转诊咨询并接受了血管内神经外科手术。召开了神经外科委员会会议，讨论脑全脑血管造影结果及血管内治疗方案。脑全脑血管造影显示为Cognard IV型硬脑膜动静脉瘘，因此建议采用Phil栓塞液体材料和三轴球囊进行血管内治疗，以降低静脉高压。通过直接汇入瘘管的右脑膜动脉后支进行插管。6个月后进行了第二次干预，同样通过右股动脉采用Phil栓塞液体材料和球囊进行血管内治疗。此次干预发现硬脑膜动静脉瘘残留，右侧窦内有静脉瘤。在几年时间里，每隔约7个月进行了另外3次干预，实现了部分闭塞。在第五次干预期间，患者出现神经功能恶化，促使进一步进行影像学检查以评估上矢状窦血栓形成情况。给予了栓塞液体材料的血管内治疗和皮质类固醇治疗。
