复合手术治疗复杂硬脑膜动静脉瘘近中期效果

The short-to-mid-term curative effect of hybrid surgery for complex dural arteriovenous fistula

目的探讨复合手术治疗复杂硬脑膜动静脉瘘(DAVF)的近中期临床效果。方法回顾性分析2017年1月至2018年12月南方医科大学南方医院收治的20例DAVF患者临床资料,其中符合纳入标准的8例接受复合手术治疗。术后定期随访复查头颅CT/MRI和DSA评估瘘口闭合情况,评估神经功能、改良Rankin量表(mRS)评分变化。结果术中即刻造影显示瘘口完全闭塞7例(7/8),近完全闭塞1例(1/8)。术后2周1例因突发肺栓塞死亡。随访3~24个月,复查CT/MRI和DSA显示7例恢复良好,均无新发神经功能障碍,既往严重临床症状得到改善,mRS评分下降至2~3分。结论复合手术治疗静脉窦闭塞或多"共同通道"的复杂DAVF,可提供明确的治疗入路,通过一次全面手术使瘘口彻底永久性闭合,术后近中期临床预后较好。

Objective To explore the short-to-mid-term curative effect of hybrid surgery for complex dural arteriovenous fistula(DAVF). Methods The clinical data of 20 patients with DAVF, who were admitted to Southern Hospital of Southern Medical University of China during the period from January 2017 to December 2018, were retrospective analyzed. Among the 20 patients, 8 patients who met the inclusion criteria received hybrid surgery. After treatment, the patients were periodically followed up, reexaminations of cerebral CT/MRI and DSA were performed to assess the closure status of fistula, the neurological functions were evaluated, and the changes in Rankin scale(mRS) scores were recorded. Results Intraoperative instant angiography showed that complete occlusion of fistula was achieved in 7 patients(7/8) and subtotal occlusion of fistula was achieved in one patient(1/8). Two weeks after treatment, one patient died due to sudden pulmonary embolism. The patients were followed up for 3-24 months, CT/MRI and DSA examination revealed that satisfactory recovery was obtained in 7 patients and no newly-developed neurological dysfunction was observed. Conclusion For the treatment of complex DAVF associated with venous sinus occlusion or multiple "common channels", hybrid surgery can provide a clear therapeutic approach, and through a single comprehensive surgery a complete and permanent occlusion of the fistula can be achieved with satisfactory short-to-mid-term effect.