舌下神经管区硬脑膜动静脉瘘介入治疗二例

Hypoglossal canal dural arteriovenous fistulas treated with transvenous embolization:report of two cases and literature review

介绍两例舌下神经管区硬脑膜动静脉瘘患者的临床表现、影像学诊断、手术过程及疗效。两例患者临床均表现为结膜充血水肿伴耳鸣,三维深度感知飞行时间(3D-TOF)高分辨磁共振检查可见舌下神经管区异常紊乱血管影。脑血管造影检查发现该硬脑膜动静脉瘘由多支颅内外动脉供血,瘘口位于舌下神经管区域。通过静脉途径使用弹簧圈和Onyx-18胶闭塞该动静脉瘘,术后血管造影提示瘘口完全闭塞,患者症状迅速缓解且无手术并发症,术后随访无复发。

Two cases of hypoglossal canal dural arteriovenous fistulas （HCDAVF） were reported. The clinical manifestation, radiological features, treatment and prognosis were reviewed. Both cases presented chemosis and pulsatile tinnitus. 3D-time-of-flight （T OF） magnetic resonance angiography （MRA） demonstrated abnormal high signal in hypoglossal canal. Cerebral digital subtraction angiography （DSA） showed that these HCDAVFs were supplied by multiple intracranial and extracranial arteries, and fistulas were located in hypoglossal canal. Fistulas were blocked by coils and Onyx-18 through transvenous approach, and the angiography after the embolism showed complete occlusion of fistula. No adverse events after treatment and no recurrence during the follow up were observed.