Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases

Background  Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.
Methods  From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.
Results  All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.
Conclusions  Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.

     

Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via transvenous approach

Cavernoussinusduralarteriovenousfistulas (CSdAVFs)formacomplexcommunicationnetworkbetweenthecavernoussinus (CS)andtheduralbranchesoftheexternalcarotidartery (ECA)and/orinternalcarotidartery (ICA) CSdAVFsusuallybecomesymptomaticspontaneouslyandoccurmostofteninelderlywomen TheclinicalmanifestationsofCSdAVFsdependonthepatternofvenousdrainage Chemosis ,conjunctivalcongestion ,bruit,ophthalmoplegia ,eyelidswelling ,proptosis,diplopia ,andvisualacuityimpairmentmayallresultfromCSdAVFs 1 …     

经静脉入路栓塞治疗硬脑膜动静脉瘘27例临床分析

目的探讨经静脉途径栓塞治疗硬脑膜动静脉瘘(DAVF)的疗效.方法经全脑血管造影(DSA)确诊硬脑膜动静脉瘘27例,其中海绵窦区18例,横窦、乙状窦9例,均经静脉途径予以栓塞治疗.结果本组27例中治愈22例,症状好转5例,无加重和死亡.随防2个月～8年,无复发及加重者.结论静脉入路栓塞治疗硬脑膜动静脉瘘是一种安全、有效的方法.     

海绵窦区硬脑膜动静脉瘘的治疗探讨

目的 探讨海绵窦区硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)的治疗方法、效果及预后.方法 25例患者中8例行颈动脉压迫或仅随访观察;17例行血管内栓塞,其中3例经静脉途径栓塞,13例经动脉途径栓塞,其中1例联合使用覆膜支架和Glubran胶治疗,1例经动脉途径治疗后再次接受经静脉途径栓塞治疗.结果 8例行颈动脉压迫或随访观察的患者中有4例症状缓解或消失,其余患者无加重;3例经静脉途径栓塞者均通过同侧或对侧岩下窦入路完全闭塞瘘口;13例经动脉途径栓塞者中4例完全闭塞瘘口,其余患者症状部分缓解;1例患者首次经动脉途径部分栓塞术后症状加重,急诊经眼上静脉穿刺置管完全栓塞.结论 海绵窦区DAVF总体预后良好,可根据患者症状和影像学特征选择恰当的治疗方式,经静脉途径栓塞治愈率高,适宜者应作为首选治疗方法.     

Update of embolization of intracranial dural arteriovenous fistula

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous communications within the dura locating near a major venous sinus and are supplied by pachymeningeal arteries. DAVFs represent 10–15% of all intracranial arteriovenous malformations. The natural history and clinical manifestations are determined by location of the DAVFs and their angioarchitecture. Aggressive DAVF is usually associated with leptomeningeal venous drains or reflux. It may present with hemorrhagic or nonhemorrhagic stroke. The goal of embolization of DAVFs is total fistula occlusion without interfering with the normal dura–venous drains. Embolization can be performed by transarterial and/or transvenous routes or direct puncture of affected dural sinus. Selection of embolic materials depends on access route and angioarchitecture of the fistula. With the involution of endovascular devices, embolic materials, and high-quality angiography, endovascular embolization of DAVFs has been proved a safe and effective method of treating these complex cerebrovascular lesions.     

Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via

Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including its indications, complications and efficacy.Methods Eight patients with symptomatic CSdAVFs were treated by endovascular embolization with platinum coils, via the inferior petrosal sinus (IPS) in 6 patients, and via the Sylvian vein after surgical exposure in other 2 patients.Results Complete angiographic resolution of the fistula was obtained in six patients immediately after the procedures, and a complete resolution of symptoms and signs was achieved in all patients. The residual fistulas in two patients disappeared completely in the follow-up angiography.Conclusion Transvenous embolization is a useful and safe approach in the management of CSdAVFs.     

Acute paraplegia following embolization of spinal dural arteriovenous fistula

Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

     

Transvenous treatment of a complex cavernous sinus dural arteriovenous fistula secondary to balloon embolization of a traumatic carotid-cavernous fistula

Although recurrent traumatic carotid-cavernous fistula （CCF） and its treatment have beenreported sporadically,^1 a complex cavernous sinus dural arteriovenous fistula （DAVF） secondary to balloon embolization of a direct traumatic CCF is rare. In 2005, we treated such a case via transvenous approach using coils and N-buty-2- cyanoacrylate （NBCA）. The causes of recurrent cavernous sinus DAVF and its endovascular approach are discussed.     

Tentorial dural arteriovenous fistula successfully treated with surgical interruption of leptomeningeal venous drainage: a case report

Tentorial dural arteriovenous fistula (DAVF) is a rare disease, accounting for some 4% of all cases of intracranial DAVF. 1 Because of a high risk of intracranial hemorrhage, patients with DAVF need aggressive treatment. Despite recent advances in endovascular technology, many researchers advocate open surgery for the treatment of tentorial DAVF.     

硬脑膜动静脉瘘65例

目的：对硬脑膜动静脉瘘临床诊断治疗特点进行探讨。方法：对60例患者行血管内栓塞治疗，5例行颈动脉压迫法治疗。其中13例1次栓塞，25 例行2次栓塞，17例行3次栓塞，5例行4次或多次栓塞，结果：治愈36例，好转25例，4例无效，无一例死亡，结论：硬脑膜动静脉瘘的临床表现和预后与其发病部位，静脉引流类型密切相关，颈动脉压迫法及选择性血管内栓塞是安全有效的治疗方法。     

脑膜中静脉硬脑膜动静脉瘘9例与文献汇总分析

目的：脑膜中静脉硬脑膜动静脉瘘(Middle Meningeal Vein Dural Arteriovenous Fistula,MMV-DAVF)少见,本文总结其影像学特点、临床表现和血管内治疗。方法：回顾性收集我科自1999年1月至2020年4月之间收治9例MMV-DAVF患者的临床资料、影像学资料和手术及随访资料,并在数据库中检索中英文文献,纳入文献报道中23例患者的上述资料,并作汇总分析。结果：本组9例患者,多数具有外伤史(7/9,77.8%),头痛、颅内杂音是最常见的临床表现,多合并颅骨骨折(4/6,66.7%)及颅内出血(5/6,83.3%)。均经MMV引流至临近静脉窦或静脉丛,所有9例患者均采用血管内Onyx栓塞,7例(77.8%)术后完全栓塞,2例(22.2%)次全栓塞,随访未见复发和新发。综合文献和本组患者共32例患者,有头部外伤史占78.1%,65.6%合并颅骨骨折,62.5%伴有脑部血肿。46.9%表现为头痛,37.8%伴有颅内杂音。62.5%采用动脉入路血管内介入治疗,完全栓塞率80.0%,术后随访未出现DAVF复发和新发。结论：MMV-DAVF少见,但在合并颅骨骨折的情况下,若出现颅内杂音和头痛,应进一步行血管学检查,治疗方式首选血管内介入栓塞治疗。     

脊髓硬脊膜动静脉瘘6例临床分析

目的:探讨脊髓硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)的临床特征、影像学特点及治疗,以期提高对SDAVF的早期识别和诊断.方法:对上海市普陀区人民医院神经外科收治住院的6例SDAVF患者临床表现、影像学资料及治疗进行回顾性分析.结果:6例患者中5例为男性,1例为...     

海绵窦区硬脑膜动静脉瘘的栓塞治疗

目的　探讨海绵窦区硬脑膜动静脉瘘的治疗方法。方法　海绵窦区硬脑膜动静脉瘘共 12例 ,经颈外动脉以微粒栓塞 3例 ;以正丁基氰基丙烯酸异丁酯 (NBCA)栓塞 2例 ;经颈外动脉插入海绵窦以NBCA栓塞1例 ;经岩下窦以机械可脱性弹簧圈 (MDS)栓塞 1例 ;经眼上静脉以MDS栓塞 5例。结果　瘘口完全消失 8例 ;瘘口残留 4例 ,其中 2例瘘口残留患者 3个月后症状好转。结论　根据不同的类型 ,经静脉栓塞和经动脉栓塞均可作为海绵窦区硬脑膜动静脉瘘的有效治疗方法     

经动脉途径以低浓度氰基丙烯酸正丁酯栓塞硬脑膜动静脉瘘的疗效分析

目的 探讨经动脉途径以低浓度氰基丙烯酸正丁酯栓塞治疗硬脑膜动静脉瘘的技术方法和疗效。方法 采用低浓度（10％～20％）氰基丙烯正丁酯（NBCA）经供血动脉对18例不同部位硬膜动静脉瘘患者进行栓塞治疗。18例患者中海绵窦区硬膜动静脉瘘12例，顶部硬膜动静脉瘘6例。该技术的关键操作方法是将低浓度NBCA注入静脉端使之闭塞并反流入其他供血动脉。结果 18例患者中17例在栓塞后达到解剖治愈，术后临床症状消失。另1例通过海绵窦区硬膜动静脉瘘栓塞后一度症状好转，2d后症状加重，复查造影发现静脉未完全闭塞，回流静脉发生改变，经压颈10d后症状明显好转。结论 经动脉途径以低浓度NBCA栓塞治疗硬脑膜动静脉瘘对于有些病例是较好的选择，其特点是低廉、快捷，疗效满意。     

硬脊膜动静脉瘘二例

硬脊膜动静脉瘘(Spinal dural arterio-venous fistula,SDAVF)是指供应脊膜或神经根的细小动脉,在椎间孔处穿过硬脊膜时与脊髓引流静脉的交通.静脉反向引流至脊髓表面,导致脊髓回流受阻,产生椎管内静脉高压,导致脊髓充血、水肿甚至坏死[1].现将我们诊治的2例报道如下.     

Transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes

Objective：To evaluate the safety and efficiency of transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes. Methods： Twenty seven patients with dural arteriovenous fistula of cavernous region were treated by transvenous embolization with micro-coils. The transvenous routes included inferior petrosal sinus, superior ophthalmic vein and facial vein. Results： Clinical cure was achieved in 23 cases and significant improvement of symptoms in 4 cases. Complete anglographic obliteration was documented in 22 patients （82%）. Residual shunting were left in 2 patients via pterygoid drainage and 1 case via inter-cavernous sinus, 2 cases via inferior petrosal sinus, disappeared one month later by manual compression carotid artery. Headache and vomiting were the most common symptoms after embolization. Three patients had diplopia and relieved within two months after embolization. There was no permanent procedure-related morbidity. The clinic follow up ranged from 5 months to 6 years, and there was not recurrence case. Conclusion： Transvenous embolization via different venous routes is a safe and efficient method for dural arteriovenous fistula of cavernous region treatment.     

不典型硬脊膜动静脉瘘6例临床分析

硬脊膜动静脉瘘(SDAVF)是脊髓血管畸形疾病中最常见的一种,主要表现为横贯性脊髓损害,影像学多表现为长节段脊髓病变伴脊髓表面增多迂曲血管影.该病临床上相对少见,并且可有不典型表现,极易漏诊或误诊为脊髓炎性反应性疾病或椎间盘退行性变等,早期诊断和治疗能明显改善预后.文章对6例不典型SDAVF患者临床特征和实验室资料进行...     

87例硬脊膜动静脉瘘的MRI征象分析

目的 探讨硬脊膜动静脉痿临床特点、MRI表现及其对硬脊膜动静脉瘘早期诊断的价值,提高对该病的认识.方法 回顾性分析87例已确诊为硬脊膜动静脉瘘患者的临床资料及MRI影像,对其临床特点及MRI表现进行分析.结果 硬脊膜动静脉瘘多见于中老年男性,病程长,临床表现为下肢运动、感觉及大小便功能障碍,MRI特点为T2像髓内高信号100%,T2像周围的低信号影97.70%,T2像、T1像脊髓表面血管流空影97.54%、74.71%.60.7%的患者有明确误诊.结论 硬脊膜动静脉瘘临床表现多样,缺乏特异性,造成本病误诊率高,但其临床特点及MRI表现对硬脊膜动静脉瘘早期诊断有较高价值.