2016 年 10 巻 5 号 p. 264-271
Purpose: Transvenous sinus packing with coils has been widely accepted as a curative treatment method for dural arteriovenous fistulas (DAVFs) with sinus occlusion. Some technical reports have described using luminal angioplasty or stent placement to reconstruct antegrade venous drainage. In addition, recent anatomical considerations of the parasinuses have enabled us to achieve selective embolization of the shunted venous pouch. Here, we report the technical results from five cases of DAVF with sinus occlusion treated by selective transvenous embolization combined with balloon sinoplasty (STVEBS).
Materials and Methods: Five consecutive patients who underwent STVEBS between March 2009 and March 2015 in our institution were retrospectively reviewed. All of the patients were males and were between 68 and 83 years of age. Three patients had a DAVF at the transverse sinus (TS) with ipsilateral sigmoid sinus (SS) or jugular vein (JV) occlusion. One patient had concurrent DAVFs at the right SS and left TS with left transverse sigmoid sinus (TSS) occlusion and a history of right JV ligation. The last patient had an isolated DAVF at the superior sagittal sinus.
Results: In three of the five cases, the fistula was completely obliterated by selective embolization, and antegrade sinus flow was successfully reconstructed by sinoplasty. The remaining two patients showed recanalization of DAVFs at the occluded sinus, and the sinus reopened after balloon angioplasty. These patients were subsequently treated with sinus packing. In all five patients, angiography showed complete obliteration of the DAVF. No complications occurred, and clinical symptoms improved. No recurrence was observed in any patient during the follow-up period, which ranged from 7 to 79 months, and the reconstructed sinus was patent at the last follow-up in all three patients who had undergone successful STVEBS.
Conclusion: STVEBS can obliterate DAVFs with re-establishing the antegrade sinus flow and would be an effective and safe treatment method for cases of DAVF with sinus occlusion.
