硬脑膜动静脉瘘介入诊疗与治疗.ppt

海绵窦DAVF 经静脉途径是首选的治愈性的方法 经岩下窦入路（闭塞时亦可通过） 经眼上静脉入路 其它入路：岩上窦、对侧海绵窦、基底静脉丛 Spontaneous regression of a cavernous sinus DAVF T2WI image shows multiple flow voids in the posterior cavernous sinus Left ECA angiogram shows a cavernous sinus dural AVF with posterior drainage into the inferior and superior petrosal sinuses Follow-up MR image shows resolution of the flow voids L-ECA Left ECA angiogram shows a cavernous sinus DAVF draining mainly into the inferior　petrosal sinus and pterygopharyngeal plexus Follow-up angiogram obtained 3 months　later shows that the inferior petrosal sinus is occluded, and the dural AVF　now drains into the superior ophthalmic vein and the superficial middle cerebral vein .Although　the patient’s symptoms were unchanged, occlusion of　the DAVF was indicated TVE of DAVF via an occluded inferior petrosal sinus L Superselective venogram shows that the tip of the microcatheter has been introduced into the outlets to the superior ophthalmic vein Left CCA angiogram obtained after TVE shows complete occlusion of the DAVF TVE of DAVF via an occluded inferior petrosal sinus 横窦－乙状窦DAVF 放疗+TAE-微粒 横窦－乙状窦DAVF TVE（可先栓塞供血动脉） 放疗+TAE-微粒 支架植入+TAE-微粒+放疗 TVE避免栓塞正常皮层静脉引流系统 横窦－乙状窦DAVF TVE（可先栓塞供血动脉） 支架植入 受累静脉窦及返流皮层静脉近端必须致密栓塞，以防再通致脑出血 横窦－乙状窦DAVF TVE（手术入路、经闭塞静脉窦入路、经皮层静脉入路） TAE-NBCA 手术切除（可先栓塞供血动脉） 操作难度大，要求技术高 The lateral left ECA angiogram shows a DAVF of the transverse sinus with CVR and occlusion of the ipsilateral sigmoid sinus. A transvenous approach via the contralateral transverse sinus allowed selective catheterization of a parallel channel. Venography in this parallel channel shows the veins that were draining the fistula Conversion of an aggressive DAVF to a benign(G3) This parallel channel was embolized with a combination of platinum coils and Hydrocoil A control left ECA arteriogram shows that the CVR was eliminated, although the fistula persists Conversio