静脈灌流障害の著明な横-S状静脈洞硬膜動静脈瘻に対して静脈洞形成術とステント留置術を施行した1例

抄録

Dural arteriovenous fistula (DAVF) is occasionally associated with venous/sinus stenosis. In some cases, venous congestion and venous hypertension due to venous/sinus stenosis can induce clinical symptoms. The authors report a case of transverse-sigmoid sinus DAVF treated with transvenous embolization and venous/sinus angioplasty and stenting.
A 46-year-old man presented with psychiatric symptoms and was diagnosed with Cognard type IIa+b DAVF of the left transverse-sigmoid sinus. Retrograde venous drainage was directed toward the right side via confluence. Venous/sinus stenosis in the right internal jugular vein and transverse sinus with supratentorial venous congestion were observed. DAVF was transvenously embolized, and venous/ sinus angioplasties were performed. Balloon angioplasty was performed for stenosis at the transverse sinus, and stent angioplasty was performed for stenosis at the internal jugular vein because the stenosis was not sufficiently dilated with balloon angioplasty. DAVF was totally obliterated, and the venous congestion immediately improved. The patient's clinical symptoms gradually improved postoperatively.
Venous/sinus angioplasty and stenting should be considered as a treatment for venous/sinus stenosis associated with DAVF.