Impact of transvenous embolization via superior ophthalmic vein on reducing the total number of coils used for patients with cavernous sinus dural arteriovenous fistula
Impact of transvenous embolization via superior ophthalmic vein on reducing the total number of coils used for patients with cavernous sinus dural arteriovenous fistula
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DOI：
10.1007/s10143-019-01227-9
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发表时间：
2019-12-23
影响因子：
2.8
通讯作者：
Kohmura, Eiji
中科院分区：
文献类型：
--
作者：
Fujita, Atsushi;Kohta, Masaaki;Kohmura, Eiji
虽然经上级眼静脉（SOV）的经静脉栓塞（TVE）被用于治疗海绵窦硬脑膜动静脉瘘（CS DAVF），但其对弹簧圈体积的影响很少了解。本研究的目的是调查当比较两种入路策略时，使用的弹簧圈总数和患者安全性是否存在差异。我们回顾性审查了2008年1月至2018年3月期间接受TVE治疗的CS DAVF患者的图表。比较了基线患者特征、手术细节、放置的弹簧圈和临床结果。共42例CS DAVF患者采用岩下窦（IPS）（n = 32）或SOV（n = 10）入路治疗。经SOV的TVE显示经股动脉入路的高成功率为100%（10/10）。经SOV治疗的患者的弹簧圈总数（23 vs 11; P < 0.001）、长度（159 vs 81 cm; P = 0.003）和体积（111 vs 46 mm（3）; P = 0.005）均显著较低。通过SOV治疗的患者通过微导管获得的初始窦内压显著更高（49与59 mmHg; P = 0.022）;然而，两种方法之间未发生与窦压升高相关的不良事件。手术并发症和颅神经麻痹的结果没有显著差异。在SOV途径可视化的情况下，应首选该方法，在所有其他情况下，应使用通过IPS的标准方法，即使无法可视化。
Although transvenous embolization (TVE) via the superior ophthalmic vein (SOV) is adopted in treating cavernous sinus dural arteriovenous fistula (CS DAVF), its effect on the coil volume is rarely understood. The purpose of the study was to investigate if there is a difference in the total number of coils used and in patient safety when comparing two access strategies. We retrospectively reviewed charts for patients with CS DAVF treated with TVE between January 2008 and March 2018. The baseline patient characteristics, details of procedure, placed coils, and clinical results were compared. A total of 42 patients with CS DAVF were treated with the inferior petrosal sinus (IPS) (n = 32) or SOV (n = 10) approach. TVE via SOV showed a high success rate of 100% (10/10) by transfemoral access. The total number (23 versus 11; P < 0.001), length (159 versus 81 cm; P = 0.003), and volume of placed coils (111 versus 46 mm(3); P = 0.005) were significantly lower in patients treated via SOV. Patients treated via SOV had significantly higher initial intrasinus pressure (49 versus 59 mmHg; P = 0.022) obtained by microcatheters; however, no adverse events occurred related to elevated sinus pressure between both approaches. Procedural complications and cranial nerve palsy outcomes were not significantly different. In cases with a visualized pathway to the SOV, this approach should be preferred, in all other cases standard approach via the IPS should be used, even if it cannot be visualized.