静脉窦孤立加异常回流静脉截断术治疗静脉窦型硬脑膜动静脉瘘

Long-term efficacies of sinus skeletonization plus abnormal venous reflux interruption in the treatment of parasinus dural arteriovenous fistula

目的 分析静脉窦孤立术加异常回流静脉截断治疗大静脉窦旁硬脑膜动静脉瘘的长期效果.方法 连续性治疗15例患者中,瘘口位于上矢状窦7例,内侧横窦及窦汇附近3例,外侧横窦及乙状窦5例.症状包括颅高压,出血等.1例伽玛刀治疗无效后手术,1例栓塞后手术.患者采用静脉窦孤立加异常回流静脉截断术治疗,12例静脉窦保留,3例静脉窦完全闭塞段切除.结果 无手术死亡.出院时症状好转12例,不变2例,加重1例;随访11例,平均随访6年.KPS评分90分以上者8例,80分1例,60分和40分各1例;术后数字减影血管造影复查9例、CT血管造影1例,7例治愈,3例好转.结论 静脉窦孤立术可阻断绝大多数通向瘘口的供血动脉,达到治愈或长期缓解.

Objective To retrospectively explore the long-term efficacies of sinus skeletonization plus abnormal venous reflux interruption in the treatment of dural arteriovenous fistula interfering major dural sinus.Methods Among 15 consecutively treated patients,the lesions were located in superior sagittal sinus （n =7）,medial segment of transverse sinus （n =3） and lateral transverse and sigmoid sinus （n =5）.And 40% of them clinically presented with intracranial hypertension and 13.3% with hemorrhage.Preoperatively,Gamma knife therapy and transarterial occlusion were used in 1 case each.All underwent sinus skeletonization plus abnormal venous reflux interruption if any.Interfered sinus was preserved in 12 cases.In another 3 cases,completely occluded segment of sinus was resected after skeletonization.Results Surgical mortality was none.At discharge,the symptoms were relieved or disappeared in 12 cases.Followup study was available in 11 cases over a mean period of 6 years.A Karnofsky performance status （KPS） score of 90 or more was achieved in 8 cases and a KPS score of 80,60 or 40 was found in 1 case each.Digital subtract angiography was performed in 9 cases and computed tomographic angiography in 1 case after operation.Cure was achieved in 7 cases and 3 cases had minimal residue without recurrence.Conclusion Sinus skeletonization may stably block most blood supply to fistula so as to offer cure or long-term control of dural arteriovenous fistula.