PDF(Pubmed)
Abstract：
Transvenous embolization for cavernous sinus (CS) dural arteriovenous fistulas (CS-DAVFs) with limitations of the major access routes to the CS is challenging.
A 74-year-old woman presented with left-sided conjunctival injection and exophthalmos. Cerebral angiography showed a left CS-DAVF draining into the left uncal vein and superior ophthalmic vein, with the fistulous point located in the posterosuperior compartment of the left CS. The left inferior petrosal sinus and internal jugular vein were occluded, and no drainage route from the left superior ophthalmic vein was seen. The anterior segment of the left superior petrosal sinus (SPS) was occluded, but the posterior segment was not. Microangiography from the posterior segment of the left SPS showed a beak-like orifice in the anterior segment of the left SPS toward the left CS. A micro-guidewire was guided through the beak-like orifice, and the microcatheter was advanced into the left CS. The left CS was packed and the DAVF was occluded.
Transvenous embolization through an occluded SPS may be an option in the endovascular treatment of CS-DAVFs. Penetration along the beak-like orifice of the occluded SPS visualized by venography at the blind end of the SPS may be useful in reaching the CS via the SPS.
A 74-year-old woman presented with left-sided conjunctival injection and exophthalmos. Cerebral angiography showed a left CS-DAVF draining into the left uncal vein and superior ophthalmic vein, with the fistulous point located in the posterosuperior compartment of the left CS. The left inferior petrosal sinus and internal jugular vein were occluded, and no drainage route from the left superior ophthalmic vein was seen. The anterior segment of the left superior petrosal sinus (SPS) was occluded, but the posterior segment was not. Microangiography from the posterior segment of the left SPS showed a beak-like orifice in the anterior segment of the left SPS toward the left CS. A micro-guidewire was guided through the beak-like orifice, and the microcatheter was advanced into the left CS. The left CS was packed and the DAVF was occluded.
Transvenous embolization through an occluded SPS may be an option in the endovascular treatment of CS-DAVFs. Penetration along the beak-like orifice of the occluded SPS visualized by venography at the blind end of the SPS may be useful in reaching the CS via the SPS.
摘要：
背景：经静脉栓塞治疗海绵窦（CS）硬脑膜动静脉瘘（CS-DAVFs）的主要途径有限，具有挑战性。
方法：一名74岁女性出现左侧结膜注射和眼球突出。脑血管造影术显示左侧CS-DAVF引流到左侧脐静脉和眼上静脉，瘘管点位于左CS的后上隔室中。左岩下窦和颈内静脉闭塞，没有看到左眼上静脉的引流途径。左岩上窦(SPS)前段闭塞,但后段没有。左SPS后段的微血管造影显示，左SPS前段朝向左CS有喙状孔。一根微型导丝被引导穿过喙状的孔口，微导管前移到左侧CS。左侧CS被填充，DAVF被闭塞。
结论：通过闭塞SPS经静脉栓塞可能是CS-DAVFs血管内治疗的一种选择。在SPS的盲端通过静脉造影可视化的沿着阻塞的SPS的喙状孔口的穿透可能有助于通过SPS到达CS。
方法：一名74岁女性出现左侧结膜注射和眼球突出。脑血管造影术显示左侧CS-DAVF引流到左侧脐静脉和眼上静脉，瘘管点位于左CS的后上隔室中。左岩下窦和颈内静脉闭塞，没有看到左眼上静脉的引流途径。左岩上窦(SPS)前段闭塞,但后段没有。左SPS后段的微血管造影显示，左SPS前段朝向左CS有喙状孔。一根微型导丝被引导穿过喙状的孔口，微导管前移到左侧CS。左侧CS被填充，DAVF被闭塞。
结论：通过闭塞SPS经静脉栓塞可能是CS-DAVFs血管内治疗的一种选择。在SPS的盲端通过静脉造影可视化的沿着阻塞的SPS的喙状孔口的穿透可能有助于通过SPS到达CS。
