Marginal sinus dural arteriovenous shunts

-臨床症状, 血管撮影, 治療法の検討-

抄録

Three cases of rare dural arteriovenous shunts (dAVS) involving marginal sinus were presented with special reference to the site of abnormal arteriovenous (AV) shunting and treatment. Patients included two women and one man, ranging in age from 42 to 65 years. Clinical symptoms were bruit, headache with or without chemosis and diplopia. Angiography revealed abnormal AV-shunts situated in the marginal sinus neighboring the junction between the inferior petrosal sinus and jugular bulb. Arterial feeders contributed from the dural branches of external, internal carotid and vertebral arteries. Among them, the neuro-meningeal trunk of the ascending pharyngeal artery served as the main feeder, and dural branches of vertebral artery characteristically supplied the lesion through odontoid arterial arch collaterals in 2 cases. The lesion was drained by the veins either through the jugular bulb or through the inferior petrosal sinus. In all 3 cases, the cavernous sinus was visualized through reversed shunting flow, causing the symptoms mimicking cavernous dAVS. Trans-arterial embolization was performed in one case with clinical improvement. Trans-venous embolization using platinum coils was carried out for the rest of the patients with both angio-anatomical and clinical cure.
These lesions may represent a new clinical entity and could be recognized as marginal sinus dAVS instead of that involving the inferior petrosal sinus. Trans-venous embolization offers most curative means of treatment with fewest complications. Identification of exact AV shunting site and selection of appropriate embolization material are mandatory to achieve effective and safe embolization therapy.