显微外科手术治疗颅内高分级硬脑膜动静脉瘘

Microsurgical treatment for high-grade dural arteriovenous fistulae

目的分析颅内高分级硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)的特点及显微外科手术疗效。方法回顾性分析17例颅内DAVF病例资料,BordenⅠ~Ⅲ型为1例、4例、12例。CognardⅡ~Ⅴ型为7例、6例、2例、2例。直接行显微外科手术15例,介入栓塞+显微外科治疗2例。结果围手术期内无死亡。术后DAVF临床症状显著改善或消失16例,出现短暂的手术并发症3例。术后2周复查DSA 15例,11例无瘘口或异常静脉显影,DAVF残留4例。17例病人随访11~44个月,随访期间复查DSA 11例,其中10例无复发、达到解剖学治愈,另1例瘘口部分残留。改良RANKIN量表(modified Rankin Scale,mRS)术前为(2.41±1.37),术后为(0.47±1.23),手术前后比较差异具有统计学意义(P<0.0001)。结论颅内高分级DAVF出血风险高,需积极手术。显微外科手术治疗颅内DAVF治愈率高,并发症少,远期复发率低,是一种有效治疗方式。

Objective To analyze the characteristics of intracranial high-grade dural arteriovenous fistula(DAVF)and the efficacy of microsurgery.Methods The clinical data of 17 patients of intracranial DAVF were analyzed retrospectively,including 1 case,4 and 12 cases of Borden classification typesⅠ-Ⅲand 7,6,2 and 2 cases of Cognard classification typesⅡ-Ⅴ.The microsurgery was performed in 15 cases,and interventional embolization+microsurgery in 2.Results There was no death during the perioperative period.The clinical symptoms of DAVF were significantly improved or disappeared in 16 cases,and transient surgical complications occurred in 3.At 2 weeks after operation,review of DSA was performed in 15 cases,11 showed no fistula or abnormal vein development,and 4 cases had DAVF remnant.Seventeen patients were followed up for 11-44 months,11 cases of DSA were reviewed,and 10 cases had no recurrence and achieved anatomical cure,another case had part of the fistula remained.The modified Rankin Scale(mRS)was(2.41±1.37)before surgery and(0.47±1.23)after surgery.There was statistically significant difference before and after surgery(P<0.0001).Conclusions Intracranial high-grade DAVF has a high risk of hemorrhage and requires proper surgical intervention.Microsurgery treatment of intracranial DAVF has a high cure rate,few complications,and low long-term recurrence rate,thus being an effective treatment.