岩上静脉引流的硬脑膜动静脉瘘诊治分析

Analysis of diagnosis and treatment of dural arteriovenous fistula of super petrosal venous drainage

目的探讨岩上静脉引流的硬脑膜动静脉瘘的临床表现、影像学特点及治疗方式。方法回顾性连续纳入2013年5月至2014年9月首都医科大学宣武医院神经外科和北京海淀医院神经外科由岩上静脉引流的硬脑膜动静脉瘘患者9例,采用血管内栓塞或显微外科手术治疗,并于手术前后完善MRI、DSA检查,进行改良Aminoff&Logue量表(ALS)评分。结果 9例患者中6例为男性,3例为女性,均表现不同程度的肢体感觉及运动异常,其中7例伴有排尿和(或)排便障碍,4例患者伴有颅神经功能异常,包括声音嘶哑、饮水呛咳、呃逆、面瘫等;6例接受栓塞治疗,3例接受外科手术,均达到解剖学治愈。术前ALS评分为(6.0±2.7)分,术后3个月为(2.8±1.7)分,治疗前后差异有统计学意义(t=4.816,P<0.05)。结论岩上静脉引流的硬脑膜动静脉瘘是一类较为少见的脑血管畸形,病变累及范围广泛,临床表现严重,血管内栓塞治疗和显微外科手术均能获得较为理想的疗效,若血管条件允许,应首选介入栓塞治疗。

Objective To investigate the clinical manifestations and imaging features of dural arteriovenous fistula of super petrosal venous drainage and treatment. Methods From May 2013 to September2014,9 patients with petrosal vein drained dural arteriovenous fistula at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University and the Department of Neurosurgery,Beijing Haidian Hospital were enrolled retrospectively. The patients were treated with endovascular embolization or microsurgery,and the MRI and DSA examinations were improved,and the scores of the modified AminoffLogue scale（ ALS）were performed before and after treatment. Results In the 9 patients,there were 3 females and 6 males.They all had different degrees of limb sensory and motor abnormalities,7 of them also had urination and / or bowel disorders,4 had cranial nerve dysfunction,including hoarseness,bucking,hiccup,and paralysis. Six patients received embolization treatment,3 received microsurgery,and they all achieved anatomic cure. The preoperative ALS score was 6. 0 ± 2. 7,and the score at 3 months after procedure was 2. 8 ± 1. 7. There was significant difference between before and after treatment（ t = 4. 816,P〈 0. 05）. Conclusions The petrosal vein drained dural arteriovenous fistula is a kind of rare cerebrovascular malformation. The lesion involves a wide range. The clinical manifestations are severe. Both endovascular embolization and microsurgery can achieve a more ideal therapeutic effect. If the vascular condition is permitted,the interventional embolization treatment should be preferred.