纯脑膜动静脉瘘的血管造影及血管内治疗

Angiography and Endovascular Treatment of Pure Dural Arteriovenous Fistulae

目的 探讨纯脑膜动静脉瘘的诊断及其治疗效果。资料与方法 对 4 1例纯脑膜动静脉瘘的血管造影表现及血管内栓塞治疗进行回顾性总结、分析。选择性颈内、颈外动脉及椎动脉造影 ,了解供血动脉及瘘口的部位、血流方向及静脉窦显示情况。诊断明确后 ,将导管插入靶动脉靠近瘘口行栓塞治疗。 4 1例中 ,37例单纯行血管内栓塞治疗 ,3例栓塞后再行手术 ,l例先手术再行血管内栓塞。结果 单侧颈外动脉 1支血管供血 5例 ;双侧颈外动脉多支血管供血 2 3例 ;双侧颈内、外动脉和 /或椎动脉的脑膜支同时参与供血 13例。瘘口位于海绵窦壁 18例 ,上矢状窦壁 7例 ,横窦壁 5例 ,乙状窦壁 3例 ,脑膜静脉壁 3例 ,皮层静脉壁 5例。颈外动脉栓塞治疗有效率 87.5 % ,颈内动脉和 /或椎动脉的脑膜支栓塞治疗有效率 2 3.1%。结论 脑血管造影是确诊和研究本病唯一可靠的手段。对单有颈外动脉供血的纯脑膜动静脉瘘采用血管内栓塞治疗是安全、有效的方法。颈内动脉及椎动脉的脑膜支参与供血的情况下 。

Objective To investigate the diagnosis and management of pure dural arteriovenous fistulae (PDAF). Materials and Methods Angiographic findings and endovascular treatment results of 14 patients with PDAF were retrospectively analyzed. All patients underwent catheterization via femoral artery. Selective carotid and vertebral angiography were consequently performed to find out the feeding artery, to determine the site, flow direction and sinus vein. After clarifying the diagnosis, endovascular treatment with microcatheter was followed. Of 41 cases, simple intra-arterial embolization was carried out in 37, embolization with surgery afterwards in 3, and surgery with embolization afterwards in one. Results The fistulae were supplied by single vessel from unilateral external carotid (n=5), or by multi-vessels from bilateral external carotid (n=23), or by multi-vessels from bilateral external, internal carotid and/or meningeal branch of vertebral artery (n=13). The fistulous orifice was located at the wall of cavernous sinus (n=18), superior sagittal sinus (n=7), transverse sinus (n=5), sigmoid sinus (n=3), meningeal vein (n=3) or cortical vein (n=5). The therapeutic effectiveness was 87.5% with embolization of external carotid artery, and was 23.1% with embolization of internal carotid and/or meningeal branch of vertebral artery.Conclusion Cerebral angiography is the only reliable means to confirm the diagnosis of PDAF. For PDAF that is supplied by external carotid alone, endovasular embolization is an effective and safe therapy. For PDAF that is supplied by internal carotid and/or meningeal branch of vertebral artery, surgery should be carried out following endovascular embolization.