硬脑膜动静脉瘘的治疗分析(附15例报告)  

Choice of treatment methods for dural arteriovenous fistulas(report of 15 cases)

作　　者：蔡明俊[1] 马廉亭[2] 黄绳跃[1] 杨铭[2] 潘力[2] 魏晨斌[1] 魏德[1] 杨波[1] 

机构地区：[1]福建省立医院神经外科,福州350001 [2]广州军区武汉总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2013年第12期708-710,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨硬脑膜动静脉瘘的治疗方法及其效果。方法回顾性分析2010年9月到2012年9月收治的15例硬脑膜动静脉瘘病人的临床资料。手术治疗4例,血管内治疗7例,伽玛刀治疗2例,保守治疗2例。结果手术治疗的4例患者均恢复良好。血管内治疗的7例患者中,5例术后即刻行造影显示硬脑膜动静脉瘘消失,未发生并发症;另2例栓塞后有少量残留,通过压迫供血的颈总动脉治愈。伽玛刀治疗2例,随访1年症状好转。保守治疗的2例患者,通过压迫供血的颈总动脉,其中1例成功治愈,另1例好转。15例患者出院后随访6～30个月,7例血管内治疗患者中2例复发,1例再次栓塞后治愈,1例通过压迫供血的颈总动脉及伽玛刀治疗后好转;随访期间15例患者均无神经功能缺失表现。结论硬脑膜动静脉瘘应针对其部位及类型,选择相应的治疗方法;血管内治疗安全、有效,是其首选方法。Objective To explore the treatment methods of dural arteriovenous fistulas （DAVFs）. Methods The clinical data of 15 patients with DAVF admitted to our hospital from September 2010 to September 2012 were analyzed retrospectively. Three patients with DAVF of the anterior cranial fossa and one patient with DAVF of the posterior cranial fossa received microsurgery. Seven patients with DAVF of the cavernous sinus received endovaseular embolization. Two patients whose feeding artery was external carotid artery received conservative treatment of external manual carotid compression. Two patients with tentorial DAVF received gamma knife radiosurgery. The follow-up time ranged from 6 months to 30 months. Results Four patients receiving microsurgery recovered well, and the postoperative computed tomography angiography or DSA showed that all fistulas in 4 patients were completely occluded. The DSA immediately after the endovascular embolization showed that the DAVFs were completely occluded in 5 patients without postoperative complications and greatly partially in 2 patients who received external manual carotid compression. Of 7 patients receiving endovascular embolization, 2 patients recurred, of whom, one was cured by re-embolization and one received gamma knife radiosurgery. The symptom relief was achieved in 2 patients receiving gamma knife radiosurgery. Of 2 patients receiving conservative treatment, one was cured and one impoved. Conclusions The treatment method should be selected according to the location and the type of DAVF. The endovaseular treatment is a safe and effective method and should be the first choice for treatment of DAVF.

关 键 词：硬脑膜动静脉瘘 治疗 效果 

分 类 号：R743.4[医药卫生—神经病学与精神病学] R651[医药卫生—临床医学]