手术治疗硬脑膜动静脉瘘

Surgical resection of cerebral dural arteriovenous fistulas (DAVF)

目的探讨手术切除硬脑膜动静脉瘘的方法。方法2005年5月至2006年6月共收治8例难治性硬脑膜动静脉瘘患者,男性6例,女性2例,年龄25-42岁。病变部位以双侧大脑凸面硬脑膜为主3例,乙状窦小脑幕病灶2例,前颅窝和眶尖病灶1例,矢状窦双侧乙状窦1例。手术依据病灶部位,选择额颞、颞枕、额下、乙状窦前或联合入路,电凝、离断病灶供血动脉,切除受累的病变硬脑膜,沿动脉化静脉分流方向寻找瘘口,切断动静脉分流,必要时也可切断压力较高严重动脉化的静脉窦,改善静脉回流,恢复神经功能缺失。结果8例中5例病人术后症状消失或明显好转。硬脑膜动静脉瘘消失,1例手术中出血死亡。结论手术切除各种复杂硬脑膜动静脉瘘可作为一种有效的方法,但应防止术中较大的动静脉瘘和静脉窦撕裂产生的致命性出血。

Objective To confirm the effectiveness of surgical reection of cerebral dural arterivenous fistulas（DAVF）.Methods From May 2005 to June 2006,8 cases of DAVF ,6 Male,2 Female.25-42 years old.Tinnitus in 2 cases,headache in 1 case ,SAH 1 case,proptosis,pulsatile tinnitus in on case and visual impairment in 1 cases,The surgical cranoacetomy and approaches were selected according to the lesion location.The feeding arteries were coagulated and cut,the involoved dural were resected,the fistula was verified by the blood flow direction within the vascular lesions.When it is necessary,those arterized veinous sinus can be coagulated and obliterated to eliminate the high flow and pressure.Results In 5 patients ,the preoperative symptoms disappeared immediately after surgery.The postoperative angiography in 5 patients showed the abolition of the fistulas.One death occurred due to a huge hemorrhage during surgical procedure.Conclusions Surgical resection of various dural arterial-venous fistula could be practical and effective while a sinus and venous laceration leading to a fatal hemorrhage should be avoided.