硬膜動静脈瘻の塞栓術
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概要
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Symptoms of dural arteriovenous fistulas (AVFs) vary from asymptomatic-mild symptoms to fatal hemorrhage. The best treatment should be selected among several treatment options, including open surgery, interventional techniques, stereotactic radiation therapy, and conservative management, based on the condition of the patient, risks of aggravating symptoms, and risks related to each technique. Although the majority of cases with dural arteriovenous fistulas can be treated by interventional techniques including transarterial embolization and transvenous embolization, application of interventional techniques has to be selected based on the angioarchitecture and hemodynamic features of the dural AVFs and venous drainage from normal neural tissue. Non-sinusal dural AVFs/spinal dural AVFs are highly associated with aggressive symptoms, and should be completely occluded by open surgery or transarterial embolization with liquid embolic materials. Selection of the two techniques depends on the location of the fistula (deep or superficial) and presence of dangerous feeding arteries. Transvenous embolization should be considered as a first-line option for the treatment of sinusal dural AVFs/spinal epidural AVFs. Selective transvenous embolization of the shunted venous pouch has been recently applied for the treatment of sinusal dural AVFs. It can selectively occlude the fistulous pouches of dural AVF with preservation of the sinus lumen for cases with dural AVF with antegrade sinus flow. Sinus packing should be performed for cases in which the affected sinus does not serve as a route of cerebral venous drainage. Careful attention should be paid to small retrograde cerebral venous drainage of dural AVFs during sinus packing because residual retrograde drainage to a small cerebral vein can cause fatal hemorrhage or venous infraction during or after sinus packing. Pretherapeutic evaluation of the drainage veins of dural AVFs, cerebral venous drainage, location of the fistulas, shunted venous pouches, and feeding arteries is essential to achieve a safe and successful procedure.
- 一般社団法人日本インターベンショナルラジオロジー学会の論文