Endovascular treatment of dural arteriovenous fistula involving marginal sinus with emphasis on the routes of transvenous embolization
Endovascular treatment of dural arteriovenous fistula involving marginal sinus with emphasis on the routes of transvenous embolization
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DOI：
10.1007/s00234-011-0852-4
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发表时间：
2012-02-01
期刊：
影响因子：
2.8
通讯作者：
Ahn, Sung Soo
中科院分区：
文献类型：
--
作者：
Choi, Hyun Seok;Kim, Dong Ik;Ahn, Sung Soo
累及边缘窦的硬脑膜动静脉瘘是比较罕见的。经静脉栓塞是一种有效的治疗方法。边缘窦周围的区域解剖结构包括复杂的颅颈骨结构和丰富的静脉连接。因此，累及边缘窦的硬脑膜动静脉瘘可能有多种经静脉入路。本文旨在分析硬膜边缘窦性动静脉瘘的血管内治疗方法，重点介绍经静脉栓塞的途径。回顾性分析5例经静脉栓塞治疗累及边缘窦的硬脑膜动静脉瘘（DAVFs）的血管内治疗：血管造影结构、静脉入路及治疗结果。除经静脉栓塞后出现头痛、眼痛和面部潮红外，无明显并发症。4例患者的即时血管造影结果完全，1例患者部分。随访期间临床结果为4例患者完全康复，1例患者出现间歇性耳鸣。采用三种不同的经静脉入路进行经静脉线圈栓塞：3例患者采用同侧颈内静脉，1例患者采用对侧颈内静脉，1例患者采用椎静脉丛。经静脉线圈栓塞治疗边缘窦性深静脉瘘是一种安全有效的方法。如果颈内静脉入路失败，应考虑其他栓塞途径。了解颅颈交界处的局部静脉解剖对瘘部位的定位和选择经静脉栓塞的途径是重要的。
Dural arteriovenous fistulas involving marginal sinus are relatively rare. Transvenous embolization is a curative treatment of choice for them. Regional anatomy surrounding the marginal sinus comprises complex craniocervical bony structures and abundant venous interconnections. Therefore, dural arteriovenous fistulas involving marginal sinus may have various routes for a transvenous approach. The purpose of this article was to analyze endovascular treatment of marginal sinus dural arteriovenous fistulas with emphasis on the routes of transvenous embolization.Five patients with dural arteriovenous fistulas (DAVFs) involving the marginal sinus who were treated with transvenous embolization were retrospectively analyzed in terms of endovascular treatment: angiographic architecture, routes of venous approach, and treatment results case by case.There were no significant complications except for headache, ocular pain, and facial flushing after transvenous embolization. Immediate angiographic outcomes were complete in four patients and partial in one patient. Clinical outcomes during follow-up were complete recovery in four patients and intermittent tinnitus in one patient. Three different transvenous approaches were used for transvenous coil embolization: ipsilateral internal jugular vein in three patients, contralateral internal jugular vein in one patient, and vertebral venous plexus in one patient.Transvenous coil embolization in treating marginal sinus DAVF is a safe and effective method. In case of failure of an internal jugular venous approach, alternative routes of embolization should be considered. Understanding the regional venous anatomy of the craniocervical junction is important for targeting fistulous sites and selecting routes for transvenous embolization.