脑发育性静脉异常的诊断和治疗

The diagnosis and treatment of intracranial developmental venous anomalies

目的探讨脑发育性静脉异常（DVAs）的诊断和治疗方法。方法回顾1988年至2010年57例DVAs病例，分析总结头颅CT、MRI和DSA检查的影像学特点及手术指征。结果DVAs表现为癫痫、出血、肢体活动障碍和颜面部血管瘤等。其典型影像学特点为脑深部髓静脉扩张，呈放射状伞样排列，汇聚成粗大引流静脉，向表浅或深部引流。57例中，保守治疗42例，手术治疗15例。开颅手术中2例单纯切除DVAs，2例切除伴发的动静脉畸形，11例切除伴发的海绵状血管瘤。结论DVAs具有典型的影像学特点，临床过程趋于良性，多数未出血的患者可予保守治疗，有颅内出血者多因伴发的海绵状血管瘤或动静脉畸形所致，可以手术切除，但应尽量保留粗大的引流静脉。

Objective To study the diagnosis and treatment methods of intracranial developmental venous anomalies （DVAs）. Methods Fifty - seven DVAs were retrospectively studied from 1988 to 2010. The characteristic of DVAs in CT, MRI, and DSA examination were studied and different treatment strategies were suggested based on specific conditions. Results The clinical presentasions includes epilepsy, intracerebral hemorrhage, hemiparasis, and facial hemangioma. Typical imaging characteristics is wedge or umbrella- shaped collections of dilated medullary veins converging in an enlarged subependymal or transcortical collector vein, draining to superficial or deep vein system. Of the 57 cases, 42 were treated conservatively and 15 were treated by open surgery. In open surgery, two pure DVAs were resected, two associated arteriovenous malformations （AVMs） were resected, and eleven associated cavernous angiomas （CMs） were resected. Conclusions DVAs has a benign natural history and typical imaging characteristics. The vast majority of DVAs could be treated conservatively. Intracerebral hemorrhage usually attributes to associate with AVMs or CM. The associated lesions could be resected while the draining vein should be preserved as far as possible.