Endovascular surgery for the treatment of spontaneous carotid cavernous fistulas. Its pitfalls and problems.:Its pitfalls and problems
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概要
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We carried out endovascular surgery for the treatment of 50 cavernous dural arteriovenous fistulas (CdAVF). Transarterial embolization with alcohol, glucose and/or polyvinyl alcohol (PVA) particles was successfully performed in 8 of 10 cases with mild arteriovenous shunt flow. Transvenous embolization with copper wires, a segmented guide wire and/or platinum microcoils was successfully performed in 36 of 39 cases. Generally, transvenous approaches via an anterior route (angular vein to SOV), medial route (intercavernous sinus) and posterior route (jugular vein to IPS) made the embolization of the CdAVF successful. Although only fistulas should be occluded, a part or all of the cavernous sinus including fistulas is usually packed with coils. In the case of stenotic or occlusive IPS, multi-stage embolization should be avoided because a relatively increased venous flow after incomplete embolization of the fistulas and occlusion of abnormal draining routes such as the SOV and sphenoparietal sinus may cause venous infarction or hemorrhagic infarction in the posterior fossa. Thus, embolization for CdAVF can be performed safely and perfectly, if an appropriate strategy of occlusion is selected for each patient.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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