硬脑膜动静脉瘘的分型及临床意义

Classification of intracranial dural arteriovenous fistula and its clinical signification

目的 探讨硬脑膜动静脉瘘 (DAVF)的影像学分类及临床意义。方法 对 110例DAVF患者 ,12 1个病变按部位进行分区 ,分别为硬膜窦区、海绵窦区、天幕区、颅底静脉丛区、大脑镰区。按引流静脉分类 ,Ⅰ型瘘口直接向脑膜静脉或硬脑膜窦引流 ;Ⅱ型向硬脑膜窦回流后反流入脑或脊髓静脉 ;Ⅲ型直接向脑或脊髓静脉回流。结果 结合部位和引流静脉对本组病例分类结果为 :海绵窦区Ⅰ型 38例 (6 9.1% ) ,Ⅱ型 17例 30 .9% ,硬膜窦区Ⅰ型 11例 (33.3% ) ,Ⅱ型 16例 (5 6 .4% ) ,Ⅲ型 2例(10 3% ) ;而天幕区 2 0例、颅底静脉丛 6例、大脑镰区 1例均为Ⅲ型。结论 相同部位不同引流静脉类型治疗不同 ,相同引流静脉类型不同部位治疗各异 ,部位和引流静脉类型联合分类有助分析临床风险和制定治疗方案。

Objective To develop a practical imaging calssification of intracranial dural arteriovenous fistula (DAVF) based on imaging and its clinical significance. Method The lesion positions and drainage patterns of vein in 110 patients with 121 dural arteriovenous fistulas hospitalized in Xuanwu Hospital were analyzed and a new type of classification of DAVF was developed. Results The dural arteriovenous fistulas in 110 patients were classified accrding to lesion position into DAVF of dural sinus, cavernous sinus, tentorial incisure, venous plexus at skull base, and cerebral falx; or classified according to the pattern of venous drainiage into type I (draining directly into dural vein or dural sinus), type II (directly draining into dural sinus with retrograde venous drainage into cortical vein or spinal vcein), and type III (directly draining into cortical vein or spinal vein). Then, based on a combination of these two criteria, DAVF was claassified into cavernius sinus area type I (38 cases, 69.1%) and type II (17 cases, 30.9%); dural sinus area type I (11 cases, 33.3%), type II (16 cases, 56.4%), and type III (2 cases, 10.3%); and tentorial area (20 cases), skull base vein plexus area (6 cases), and cerebral falx area (1 case), all in type III. Conclusion The newly developed classification system of intracranial dural arteriovenous fistula helps analyze clinical risk and determine therapeutic procedures.