上錐体静脈洞と錐体静脈の血管解剖と関連する硬膜動静脈瘻

Angioarchitecture and Associated Dural Arteriovenous Fistulas of the Superior Petrosal Sinus and Petrosal Vein

Point

・上錐体静脈洞と錐体静脈は後頭蓋窩の静脈還流を担う重要な血管であり，さまざまな変異や側腹路が存在する．

・この部位の硬膜動静脈瘻では，錐体静脈から後頭蓋窩に逆流するため，神経症候を呈しやすく治療リスクが高い．

・周囲の硬膜動静脈瘻から錐体静脈に逆流する場合は，この逆流を確実に遮断する治療戦略が必要である．

　The superior petrosal sinus and petrosal vein are important drainage routes for the posterior cranial fossa, with some variations and collateral vessels. An anterolateral-type tentorial dural arteriovenous fistula, which occurs around the petrosal vein, often develops aggressive symptoms due to venous reflux to the brainstem and cerebellum. Neuroendovascular treatment of this fistula is usually challenging because transarterial embolization has a high risk and indications for transvenous embolization are limited. In the cavernous sinus and transverse sinus/sigmoid sinus dural arteriovenous fistulas, venous reflux to the petrosal vein is dangerous, and a treatment strategy with the occlusion of the petrosal vein is indispensable. Furthermore, attention should be paid to venous approaches through the superior petrosal sinus.