Endovascular treatment of complex dural arteriovenous fistula using the dual-microcatheter technique скачать в хорошем качестве

Endovascular treatment of complex dural arteriovenous fistula using the dual-microcatheter technique

Michael R. Levitt, M.D.,1 Joshua W. Osbun, M.D.,1 John D. Nerva. M.D.,1 and Louis J. Kim, M.D.1,2 Departments of 1Neurological Surgery and 2Radiology, University of Washington, Seattle, Washington A 71-year-old woman presented with headache and dilated vessels on CTA. Angiography demonstrated a complex dural arteriovenous fistula with retrograde cortical venous hypertension, supplied by branches of internal and external carotids bilaterally into a fistulous pouch paralleling the left transverse and sigmoid sinuses, which was occluded at the jugular bulb. The patient refused treatment and was lost to follow-up, returning with sudden confusion and hemianopsia from left temporo-occipital hemorrhage. Transvenous endovascular embolization was performed using the dual-microcatheter technique with a combination of coiling and Onyx copolymer, completely occluding the sinus and fistula while preserving normal venous drainage.