Occluded sinus for complex posterior fossa dural arteriovenous fistula / 中国脑血管病杂志

ABSTRACT

Objective: To evaluate the pathophysiology and therapeutic effect of venous sinuse embolization via Jugular vein for treatment of posterior fossa venous sinus dural arteriovenous fistula (DAVF). Methods: 10 patients with posterior fossa DAVF were diagnosed by angiography, all patients underwent endovascular embolization and cranial venous thrombosis under direct vision to dispose the segment with concentrated fistular feeders in ipsilateral sigmoid and transverse sinus after partial embolization via arterial approach. Results: Circled digit oneThe venous sinus occlusion procedure were successfully finished in 10 cases. Postoperative DSA examination showed that the fistula disappeared entirely in six patients, with more than 80% reduction in four patients. Residual fistulas have no obvious tendence of drainage to cortical veins. Circled digit twoThe murmur was disappeared and intracranial hypertension were relieved in all patients. DSA examination confirmed all the feeders were disappeared in 4 cases with craniotomy. 4 cases had followed-up and no recurrence was found. There was partial recurrence of fistula in 1 of 6 cases who underwent coil embolization and a second embolization was performed. Among five patients of declining of vision, 3 cases had different degrees of recovery after 6-12 months, 2 cases had no obviousy recovery. Five cases with edema of the optic disc were recovered. 3 patients had preoperative CSF pressure higher than 300 mm H2O, the postoperative CSF pressure reduced to 240, 230 and 200 mm H2O. Conclusion: Posterior fossa DAVF is a complicated condition, and transarterial embolization is difficult to achieve good result. The direct cerebral venous sinus occlusion and embolization via femoral vein may have curative effect to cure the posterior fossa DAVF.