Background and purpose

Angioplasty of the dural sinus has rarely been performed for the treatment of cavernous sinus dural arteriovenous fistulas. We evaluated the efficacy of selective transvenous embolization (TVE) combined with balloon angioplasty of the occluded inferior petrosal sinus (IPS) for the treatment of cavernous sinus dural arteriovenous fistulas (CSDAVFs).

Materials and methods

A total of 8 consecutive patients with CSDAVFs with occlusion of the IPS treated by selective TVE with balloon angioplasty of the IPS from July 2018 to January 2019 were retrospectively reviewed. There were 6 females and 2 males with an average age of 77.6 years. All patients showed ocular symptoms. Angiography showed cortical venous reflux in 7 cases and localized shunted pouches at the medial portion of the cavernous sinus, intercavernous sinus, or laterocavernous sinus. Selective TVE was performed via the occluded IPS with bilateral femoral venous approaches, and the occluded IPS was reconstructed by angioplasty with a 2- to 3-mm diameter balloon during or after selective TVE.

Results

CSDAVFs disappeared immediately after treatment, and the occluded IPSs were successfully reconstructed with re-establishment of normal antegrade venous flow in all cases. No complications were observed, and symptoms resolved within 2 weeks after treatment. During the 7-month mean follow-up period (range 1-12 months), no cases showed recurrence of CSDAVFs.

Conclusion

Selective TVE combined with balloon angioplasty of the occluded IPS is safe and effective for the treatment of CSDAVFs and re-establishes normal venous circulation in selected cases with localized shunted pouches.

中文翻译：

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选择性经静脉栓塞联合球囊成形术治疗闭塞的岩下窦海绵窦硬脑膜动静脉瘘

背景和目的

硬脑膜窦血管成形术很少用于治疗海绵窦硬脑膜动静脉瘘。我们评估了选择性经静脉栓塞（TVE）联合闭塞岩下窦（IPS）球囊血管成形术治疗海绵窦硬脑膜动静脉瘘（CSDAVFs）的疗效。

材料和方法

回顾性分析了2018年7月至2019年1月连续8例经选择性TVE联合IPS球囊血管成形术治疗的IPS闭塞CSDAVFs患者。女性6例，男性2例，平均年龄77.6岁。所有患者均出现眼部症状。血管造影显示7例皮质静脉反流，海绵窦、海绵间窦或后海绵窦内侧部分有局部分流袋。选择性 TVE 是通过双侧股静脉途径闭塞的 IPS 进行的，闭塞的 IPS 在选择性 TVE 期间或之后通过血管成形术用 2 至 3 毫米直径的球囊重建。

结果

CSDAVFs 治疗后立即消失，所有病例均成功重建闭塞的 IPS，重建正常顺行静脉血流。未观察到并发症，治疗后2周内症状消失。在 7 个月的平均随访期间（范围 1-12 个月），没有病例显示 CSDAVF 复发。

结论

选择性 TVE 联合闭塞 IPS 的球囊血管成形术治疗 CSDAVF 是安全有效的，并在选定的局部分流袋病例中重建正常的静脉循环。