颅前窝底硬脑膜动静脉瘘的影像学分析及治疗策略

Analysis of therapeutic strategy for dural arteriovenous fistula in anterior cranial fossa skull base

目的探讨颅前窝底硬脑膜动静脉瘘的影像学特点,并根据其而采取不同治疗方式。方法回顾性分析13例颅前窝底硬脑膜动静脉瘘病人的临床资料,病变均通过双侧眼动脉或筛前动脉供血,其中脑膜中动脉前支也参与供血7例。采用开颅手术9例,血管内治疗4例。并分析影像学特征对选择治疗方式的影响。结果术后DSA复查示所有病人的动静脉瘘均消失,均无手术并发症,术后症状逐渐好转。术后1年,DSA复查7例,均未复发。结论开颅手术治疗颅前窝底硬脑膜动静脉瘘是安全、有效的方法,对明确有硬脑膜中动脉前支供血的病变,也可行介入栓塞治疗。

Objective To investigate the therapeutic strategy of dural arteriovenous fistula in anterior cranial fossa skull base according to their imaging features.Methods Clinical data of 13 patients with dural arteriovenous fistulas in anterior cranial fossa skull base were analyzed retrospectively.The blood supply of the lesion was though the bilateral ophthalmic artery or anterior ethmoid artery of the internal maxillary artery in all the patients,and also though the anterior branch of middle meningeal artery in 7.Craniotomy was performed in 9 patients and endovascular embolization in 4.The influence of imaging features on the option of therapeutic method was analyzed.Results The postoperative DSA reexamination showed that all the arteriovenous fistulas disappeared.There was no perioperative complication,and all the clinical symptoms improved gradually postoperatively.One year after operation,DSA reexamination of 7 cases,no patients recurred during the follow-up period.Conclusions Craniotomy is a safe and effective method for the treatment of dural arteriovenous fistulas in anterior cranial fossa skull base,and endovascular embolization can be used to the lesion blood supply of which is provided by the anterior branch of the middle meningeal artery.