硬脑膜动静脉瘘的显微手术治疗

Microsurgical treatment of dural arteriovenous fistulas

目的探讨显微手术治疗硬脑膜动静脉瘘（DAVF）的优势和不同Cognard分型DAVF的手术方法。方法回顾性分析13例DAVF病人的临床资料。Cognard分型：Ⅱa型1例，Ⅱa＋lIb型5例。Ⅳ型6例，V型l例。l例海绵窦DAVF行丝线填塞术，余病例均行动脉端或静脉端DAVF瘘口切断。2例加行乙状窦结扎及颅内外静脉搭桥术。结果术后死亡l例，恢复良好12例。GOS评分：5分11例，4分l例，1分1例。随访12例，时间7个月-7年。11例复查DSA或MRA，DAVF残留2例，消失9例。结论术前明确DAVF瘘H的部位，采用合理的开颅方法和合适的手术入路，针对不同类型的DAVF采用不同的显微治疗方法．可以达到治愈DAVF的目的。

Objectives To explore the advantage of microsurgery in the treatment of dural arteriovenous fistulas （DAVF） and surgical methods for different Cognard classifications of I）AVF. Methods Clinical data of 13 patients with DAVF were analyzed retrospectively. According to Cognard classification, class Ⅱ a was found in 1 patient, class I1 a＋Ⅱ b in 5 patients, class Ⅳ in 6 and class V in 1. The silk packing was performed on 1 patient with cavernous sinus DAVF, and fistula orifices of DAVF from artery or vein end were cut off in other patients. The additional sigmoid sinus ligation and intracranial-extracranial venous bypass were performed on 2 patients. Results Good recovery was achieved in 12 patients and 1 died. The GOS scores were as follows： 5 in 11 patients, 4 in 1 and 1 in 1. Twelve patients were followed up for 7 months to 7 years. DSA or magnetic resonance angiography （MRA） was reperformed in 11 patients, DAVF remained in 2 and disappeared in 9. Conclusions With precise localization of fistula orifices of DAVF, proper method for craniotomy and suitable surgical approach, and using different treatments according to different types of DAVF, DAVF can be cured by mierosurgery.