前颅窝底硬脑膜动静脉瘘伴额叶血肿的手术治疗

Surgical treatment of dural arteriovenous fistula of anterior cranial fossa with frontal hematoma

目的探讨前颅窝底硬脑膜动静脉瘘引起前额叶血肿的诊断和显微手术策略。方法对南京大学医学院附属鼓楼医院神经外科的4例前额叶血肿患者术前行CTA和DSA检查证实为前颅窝底硬脑膜动静脉瘘,采用开颅手术电凝切断瘘口与引流静脉起始端,并清除额叶血肿。术后随访6～24个月。结果术中均顺利切断瘘口及引流静脉起始端;术后无再出血、脑挫伤、癫痫、脑脊液漏,DSA复查无瘘口复发。结论开颅手术治疗几乎适合所有的前颅窝底硬脑膜动静脉瘘患者,尤其是合并额叶血肿者,开颅手术是首选的治疗方法,优势在于治愈率高、并发症较少。

Objective To evaluate the diagnosis and microsurgical strategy of dural arteriovenous fistula(DAVF)of the anterior cranial fossa with frontal hematoma.Methods Four patients with DAVF of the anterior cranial fossa diagnosed by CTA and DSA were treated by interruptting the fistula and the beginning of the drainage vein.Patients were followed up from 6 to 24 months.Results All fistulas were completely occluded.No postoperative complications occurred.The follow-up angiography revealed no recurrence of fistula.Conclusions Microsurgery for anterior cranial fossa DAVF has the characteristics of high cure rate and fewer complications.It is a safe,effective,and preferred treatment method,especially with frontal hematoma.