经脑膜中动脉治疗10例硬脑膜动静脉瘘体会并文献复习

Treatment of 10 cases of intracranial dural arteriovenous fistulas via middle meningeal artery and literature review

目的探讨经脑膜中动脉(middle meningeal artery,MMA)治疗硬脑膜动静脉瘘(dural arteriovenous fistulas,DAVFs)的有效性及安全性。方法回顾性分析2016年3月至2020年3月经脑膜中动脉治疗的10例DAVFs患者的临床资料。计算机检索PubMed、Science Direct、中国知网、万方等数据库,对经脑膜中动脉治疗DAVFs的相关研究进行总结。结果10例DAVFs中海绵窦区3例,横窦区2例,乙状窦区2例,横窦-乙状窦区2例,窦汇区1例。术后即刻造影显示瘘口完全栓塞9例,不完全栓塞1例,术后动眼神经麻痹1例,无死亡病例。10例患者术后随访12个月,3个月及12个月复查DSA提示无复发;10例患者临床症状较前均好转或无加重。检索复习了采用MMA治疗DAVFs的9篇国内外文献,纳入研究68例DAVFs患者,MMA术后总瘘口栓塞率为91.18%,术后均无复发。结论对于有脑膜中动脉供血的DAVFs,经脑膜中动脉入路治疗DAVFs疗效确切,操作相对简单,并发症少,是路径选择中的“黄金通道”。

Objective To investigate the efficacy and safety of middle meningeal artery(MMA)for the treatment of dural arteriovenous fistulas(DAVFs).Methods The clinical data of 10 patients with DAVFs treated by MMA from March 2016 to March 2020 were retrospectively analyzed.Computer retrieval of PubMed,Science Direct,CNKI,Wanfang data and other databases were performed to summarize the relevant studies on the treatment of DAVFs by MMA.Results Among the 10 DAVFs,there were 3 cases in cavernous sinus area,2 cases in transverse sinus area,2 cases in sigmoid sinus area,2 cases in transverse sinuse-sigmoid sinus area,1 case in sinuses area.Immediate postoperative angiography showed 9 cases of complete embolization of the fistula,1 case of incomplete embolization,and 1 case of postoperative oculomotor nerve palsy without deaths.The 10 patients were followed up for 12 months after surgery,the DSA review in 3 months and 12 months indicated no recurrence in all patients,and the clinical symptoms of 10 patients were improved or no worse than before.9 domestic and foreign literatures on DAVFs treated by MMA were reviewed,68 DAVFs patients were included in the study,the total fistula embolization rate after MMA was 91.18%,no postoperative recurrence occurred.Conclusion For DAVFs with blood supply from MMA,the treatment of DAVFs via MMA approach is effective,with relatively simple operation and few complications,which is the"golden channel"in path selection.