硬脑膜动静脉瘘合并动脉瘤伴左侧头臂静脉变异一例

Dural arteriovenous fistula complicated with aneurysm and left brachiocephalic vein variation:a case report

目的探讨头臂静脉变异者的硬脑膜动静脉瘘的治疗策略。方法回顾性分析1例由深圳市第二人民医院神经外科血管病区收治的临床诊断为硬脑膜动静脉瘘患者的临床资料,通过介入手术静脉入路和术中超声引导下颈总静脉穿刺等方法栓塞硬脑膜动静脉瘘。结果通过右股静脉穿刺和静脉途径入路时,导丝到达头臂静脉区时发现导丝无法到达左侧头臂静脉,无法通过头臂静脉途径上行至病变区域,考虑左头臂静脉变异;术中使用超声引导下颈静脉穿刺置管成功栓塞硬脑膜动静脉瘘,术后复查上下腔静脉CT血管造影,检查提示左侧头臂静脉变异(左侧头臂静脉直接回流至右心房)。结论头臂静脉变异的病例极为罕见,当需要通过静脉途径入路进行介入治疗时,术前需完善上下腔静脉CT血管造影检查或上下腔静脉彩色多普勒超声检查,根据检查结果能更好地指导手术,降低手术风险。

Objective To explore the treatment strategy for cases related to dural arteriovenous fistula with brachiocephalic vein variant.Methods A retrospective analysis of the clinical data of a patient with a clinical diagnosis of dural arteriovenous fistula admitted to the Neurosurgery Vascular Ward of Shenzhen Second People's Hospital,through interventional venous approach and intraoperative ultrasound-guided common jugular vein puncture and embolization dural arteriovenous fistula.Results The right femoral vein puncture and venous approach were used.When the guide wire reached the brachiocephalic vein area,it was found that the guide wire could not reach the left brachiocephalic vein,and could not ascend to the lesion area through the brachiocephalic vein approach,which might have been caused by the variation of the left brachiocephalic vein;Ultrasound-guided jugular vein puncture was used to successfully embolize the dural arteriovenous fistula.Postoperative re-examination of the superior and inferior vena cava CT venography showed a variation of the left brachiocephalic vein(the left brachiocephalic vein directly returns to the right atrium).Conclusion The case of brachiocephalic vein variation is extremely rare.When interventional treatment through the venous route is required,CT venography of the superior and inferior vena cava or color Doppler ultrasound of the superior and inferior vena cava should be completed before the operation.The examination results can guide a better surgical method and reduce the surgical risk.