頸動脈海綿静脈洞部硬膜動静脈奇形に対する経静脈的塞栓術

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  • Embolization for Cavernous Sinus Dural Arteriovenous Malformation (Spontaneous Carotid-cavernous Fistulas)
  • -Transvernous Approach-

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We have performed embolization for spontaneous carotid-cavernous fistulas (spontaneous CCF). There were 16 cases, comprising 3 males and 13 females ranging in age from 23 to 78 (mean age: 56.). They were all type D on classification by Barrow. At first, we performed embolization of external carotid artery branches using microcoil or polyvinylalcohol particles (PVA particles) or ethylene vinyl alcohol copolymer (EVAL mixture). Subsequently we performed transvenous embolization using microcoils through internal jugular vein, inferior petrous vein to cavernous sinus or through external jugular vein to superior ophthalmic vein. Fifteen of the 16 cases were completely cured clinically and angiographically. One remaines under treatment because it was too difficult to catheterize all compartments of the cavernous sinus. After embolization, conjunctival chemosis and edema of the ipsilateral eye on all patients developed but disappeared within 2 or 3 days. There were abducens palsy and facial palsy (peripheral type) in 1 patient, and cavernous sinus syndrome in 4, but all patients recovered in 1 month. There were sigmoid sinus dural AVM in 2, which were embolized by arterial approach and improved. Transvenous embolization for spontaneous CCF is the most effective and safest treatment, but temporary complications still remain.

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