吉野 義一

[This corrects the article DOI: 10.1371/journal.pone.0310906.].

OBJECTIVE: Dural arteriovenous fistulas (dAVFs) in the paracavernous sinus of the sphenoid wing often present challenges for transvenous access because of their complex venous drainage patterns. Herein, we report the successful diagnosis and treatment of a greater sphenoid wing dAVF using a percutaneous transvenous approach via the Labbé vein. CASE PRESENTATION: A 48-year-old woman presented with tinnitus and was diagnosed with a greater sphenoid wing dAVF. The dAVF was fed by multiple meningeal arteries from the accessory meningeal artery. Shunted blood drained retrogradely into the superficial middle cerebral vein (SMCV) and bilateral inferior petrosal sinus (IPS) via the cavernous sinus (CS). Although communication was observed between the shunt pouch and the lateral part of the CS, the tortuous and narrow nature of this connection suggests difficulty in accessing the shunt pouch via the IPS. Conversely, the SMCV, which served as the primary outflow pathway, was adequately connected to the vein of Labbé with minimal difficulty, facilitating the passage of the microcatheter. The percutaneous transvenous approach via the Labbé vein successfully reached the SMCV and achieved complete obliteration with selective transvenous embolization (TVE) using coils. The symptoms of the patient improved postoperatively, and the patient was discharged without complications. CONCLUSION: Greater sphenoid wing dAVFs often rely on the SMCV as the major drainage route, making venous approaches challenging. The route via the vein of Labbé through the cortical veins to reach the SMCV proved to be a valuable access route for TVE of greater sphenoid wing dAVFs.

BACKGROUND: Endovascular treatment has become the preferred approach for managing unruptured cerebral aneurysms, with simple and balloon-assisted coil embolization as the standard first-line therapy. However, recanalization after coil embolization remains a major clinical concern. This study aimed to evaluate the predictive factors for recanalization using time-of-flight magnetic resonance (TOF-MR) angiography. METHODS: This retrospective multicenter study analyzed data from 241 patients with unruptured cerebral aneurysms who underwent coil embolization at five stroke centers. Aneurysms were evaluated using TOF-MR angiography within 7 days post-procedure and at follow-up. The study investigated the role of aneurysm characteristics and the Postoperative TOF-MR Angiography (PTMA) classification in predicting recanalization. RESULTS: Of the 241 aneurysms analyzed, 79 (32.7%) exhibited recanalization, and 15 (6.2%) required retreatment. Aneurysms with a maximum diameter of ≥10 mm were associated with a higher risk of recanalization (odds ratio (OR), 3.27; 95% confidence interval (CI), 1.38-7.75; p<0.01). The PTMA classification, which indicated incomplete occlusion (SN/RN/PO), also showed a significant association with recanalization (OR, 4.82; 95% CI, 2.17-10.7; p<0.01). The modified Raymond-Roy classification (Class IIIb) also contributed to the prediction of recanalization (OR, 3.09; 95% CI, 1.50-6.38; p<0.01). CONCLUSIONS: Aneurysm size, the modified Raymond-Roy classification, and PTMA classification within 7 days of coil embolization were significant predictors of recanalization. This study suggests that TOF-MR angiography may be accurate, and that PTMA classification may serve as an appropriate predictor of aneurysm recanalization. Further prospective studies with larger cohorts are required to validate our findings.