■尽管岩下窦(IPS)是海绵窦硬脑膜动静脉瘘(CSDAVFs)经静脉栓塞(TVE)的最常见入路,在IPS阻塞的情况下,应选择其他路线。我们报告了一例病例,其中通过面静脉(FV)的眼上静脉(SOV)入路是实现出血发作的CSDAVF的根治性治愈的首选。
■一名81岁的女性,27年前有左CSDAVF经动脉栓塞(TAE)和TVE病史。她带着意识障碍的主要抱怨被送到我们身边,头部计算机断层扫描(CT)显示右额叶皮质下出血。脑血管造影显示CSDAVF引流至右侧SOV和右侧大脑中浅静脉(SMCV)。血管造影,计算机断层扫描静脉造影,对比增强磁共振成像没有显示IPS,但是SOV的流出路径,FV,颈内静脉被证实,所以选择了通过FV的方法。
■通过右股静脉选择FV,并且由于远端进入导管(DAC)被引导到SOV,微导管可以通过海绵窦(CS)轻松引导至SMCV。进行了TVE,证实完全闭塞。当术前确认IPS闭塞时,FV对首选路线很有用,DAC的使用使我们能够准确快速地完成治疗。
UNASSIGNED: Although the inferior petrosal sinus (IPS) is the most common approach route for transvenous embolization (TVE) of cavernous sinus dural arteriovenous fistulas (CSDAVFs), other routes should be chosen in cases which the IPS is occluded. We report a case in which the superior ophthalmic vein (SOV) approach through the facial vein (FV) was the first choice to achieve radical cure of a hemorrhage-onset CSDAVF.
UNASSIGNED: An 81-year-old female presented with a history of transarterial embolization (TAE) and TVE for the left CSDAVF 27 years ago. She was transported to us with a chief complaint of consciousness disturbance, and head computed tomography (CT) showed subcortical hemorrhage in the right frontal lobe. Cerebral angiography revealed CSDAVF with draining into the right SOV and right superficial middle cerebral vein (SMCV). Angiography, computed tomography venography, and contrast-enhanced magnetic resonance imaging did not show IPS, but the outflow pathways to the SOV, FV, and internal jugular vein were confirmed, so an approach through the FV was selected.
UNASSIGNED: The FV was selected through the right femoral vein and thanks to the distal access catheter (DAC) being guided to the SOV, the microcatheter could be easily guided to the SMCV through the cavernous sinus (CS). TVE was performed, complete occlusion was confirmed. When preoperative occlusion of the IPS was confirmed, the FV was useful for the first choice of route, and the use of DAC allowed us to complete the treatment accurately and quickly.