侧窦型硬脑膜动静脉瘘的诊断及治疗探讨

Study on treatment and diagnosis of dural arteriovenous fistulae of the lateral sinus

目的：报告２７例侧窦型硬脑膜动脉瘘（ＤＡＶＦ），对其发病机理、血供与临床的关系以及治疗方法的选择进行探讨。方法：２５例病人行血管内栓塞治疗，２例栓塞结合手术治疗。结果：解剖愈合１８例，好转６例，２例无效，１例术后死于肺炎。结论：作者认为，临床表现与静脉引流类型密切相关，头痛和耳后杂音是最常见的发病症状；全脑血管造影是确诊和研究本病唯一可靠的手段；对以颈外动脉及锁骨下动脉分支供血为主者，选择性血管内栓塞治疗是安全、有效、首选的治疗方法。对颈内动脉和椎动脉脑膜支参与供血者，则以血管内栓塞结合手术治疗为宜。

Objective: To report 27 cases of dural arteriovenous fistulae (DAVF) of the lateral sinus. The pathogenesis, relationship between blood supply and clinical presentation, and the choice of treatment were discussed . Methods: The treatment modalities were endovascular embolization alone (25 cases) and embolizations followed by surgery (2 cases). Results: There were complete anatomical cure in 18 cases, angiographic improvement in 6 cases, no effect in 2 cases and one died of postoperative pneumonia. Conclusion: The authors believes that the clinical presentations chiefly depend on the type of venous drainage of DAVF. The most common symptoms were headache and auricular noises. Cerebral angiography was the most valuable means in diagnosing and investigating of the DAVF. Endovascular embolization was a safe and effective method in breating the fistulae fed by branches of the external carotid artery and subclavian artery. Endovascular embolization followed by surgery was a better method in treatment of the fistalae fed by meningeal branches of the internal carotid artery and vertebral artery.