舌下神经管区硬脑膜动静脉瘘的临床特征和栓塞治疗效果分析

Clinical characteristics and embolization efficacy of dural arteriovenous fistula of the hypoglossal canal

目的探讨舌下神经管区硬脑膜动静脉瘘(DAVF)的临床特征和血管内栓塞治疗效果。方法回顾性分析2019年10月至2021年10月于首都医科大学附属北京天坛医院神经外科学中心接受血管内治疗的舌下神经管区DAVF患者的临床资料。依据Björn Spittau的分型标准对病变进行分型。根据具体情况选择经静脉入路栓塞或动静脉联合入路栓塞。所有患者均定期门诊或电话随访,并行数字减影血管造影(DSA)检查,以观察血管内栓塞治疗效果。结果共纳入7例舌下神经管区DAVF患者。主要临床表现为搏动性耳鸣3例,球结膜充血水肿4例。Björn Spittau分型1型2例,2型5例。4例瘘口位于髁前汇右侧,2例位于髁前汇左侧,1例位于髁前汇、髁前静脉右侧。7例患者的手术均成功。经静脉入路栓塞6例,经动静脉入路联合栓塞1例。术后即刻DSA显示,7例均完全栓塞。无一例出现手术并发症。所有患者均获临床和影像学随访,中位随访时间为12个月(6~13个月),DSA结果提示无一例复发,7例患者的临床症状均消失。结论耳鸣和球结膜水肿为舌下神经管区DAVF的主要临床表现。经静脉入路或静脉联合动脉入路血管内栓塞1型和2型舌下神经管区DAVF具有较好的安全性和有效性。

Objective To investigate the clinical features of dural arteriovenous fistula of the hypoglossal canal(HCDAVF)and the efficacy of endovascular embolization treatment.Methods The clinical data of patients with HCDAVF who underwent endovascular treatment at the Neurosurgical Center of Beijing Tiantan Hospital,Capital Medical University from October 2019 to October 2021 were retrospectively analyzed.Lesions were classified based on the criterion proposed by Björn Spittau.Endovascular embolization via only vein or combined arteriovenous approach was performed depending on the specific situations.All patients were followed up by outpatient clinic visits or telephone regularly.Digital subtraction angiography was used to evaluate the efficacy of endovascular embolization.Results A total of 7 patients with HCDAVF were enrolled into this study.The main clinical symptom was pulsatile tinnitus in 3 cases and bulbar conjunctival edema in 4 cases.The fistula was located on the right side of the anterior condylar confluence(ACC)in 4 cases,on the left side of the ACC in 2,and on the right side of the anterior condylar vein and ACC in 1.Successful procedures were performed in all patients.Endovascular embolization was performed only via vein in 6 cases or combined arteriovenous approach in 1 case.Immediate postoperative DSA results showed complete embolization in all 7 cases.No postoperative complications were found.The median time of follow-up was 12 months(range:6-13 months).DSA results showed that no recurrence was detected in any of the 7 patients and clinical follow-up showed that all clinical symptoms disappeared.Conclusions Pulsatile tinnitus and bulbar conjunctival edema are common clinical manifestations in HCDAVF patients.Endovascular embolization of type 1 and type 2 HCDAVFs via only vein or combined arteriovenous approach demonstrates a good safety and efficacy profile.