颅颈交界区硬脑膜动静脉瘘的诊治分析  

Diagnostic and therapeutic analysis of dural arteriovenous fistula at the craniocervical junction

作　　者：赵亚军[1] 杨洪宽[1] 陈如东[1] 何跃[1] 于加省[1] 陈劲草[1] 陈坚[1] 雷霆[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华神经外科杂志》2016年第1期48-51,共4页Chinese Journal of Neurosurgery

基　　金：湖北省自然科学基金（2014CFBl51）;武汉市科技局科技攻关计划（200960323130）

摘　　要：目的探讨颅颈交界区硬脑膜动静脉瘘的临床特点、诊断及治疗方法。方法回顾性分析2009年9月至2015年1月华中科技大学同济医学院附属同济医院神经外科收治的13例颅颈交界区硬脑膜动静脉瘘患者的临床资料。所有患者均行全脑血管造影后确诊。10例患者经枕下后正中入路行硬脑膜动静脉瘘瘘口电凝切断术，3例随访观察。随访时间为2个月至5年。结果行手术治疗的10例患者中，9例术后行全脑血管造影检查显示原瘘口及粗大的引流静脉、动脉瘤样改变均消失；1例术后复查示瘘口尚有部分残余，再次切除后瘘口}肖失。9例以蛛网膜下腔出血起病的患者术后恢复良好，1例以三叉神经痛起病的患者术后疼痛明显缓解。随访结果显示，行手术治疗的患者无一例复发。3例随访观察的患者中，1例完全瘫痪患者死于相关并发症，2例失随访。结论颅颈交界区硬脑膜动静脉瘘临床表现无特异性，行全脑血管造影可确诊。目前通过显微外科手术常可找到瘘口并将其阻断，效果确切。Objective To investigate the clinical features, diagnosis and treatment methods of dural arteriovenous fistula at the craniocervical junction. Methods The clinical data from 13 patients with dural arteriovenous fistula at the craniocervical junction admitted to the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2009 to January 2015 were analyzed retrospectively. All patients were diagnosed after performing encephalon angiography. Ten patients were treated with microsurgery of electric coagulation cutting off fistula via the posterior median suboccipital approach. Three patients were observed and followed up. The follow-up time ranged from 2 months to 5 years. Results In the 10 patients treated with surgery, postoperative cerebral angiography showed that the original fistulas ,draining veins and aneurysmal changes disappeared in 9 cases ,in one case there was partial residue of the fistula,which was completely removed after the secondary microsurgery. 9 cases with the onset of subarachnoid hemorrhage had no significant postoperative neurological deficit. The pain in the patient who had trigemiual neuralgia relieved obviously after surgical procedure. During the follow-up period ,no recurrence was found in the postoperative patients. Among the 3 patients under observation, one case who was completely paralyzed died of related complications, the remaining 2 cases were lost. Conclusions The clinical manifestation of dural arteriovenous fistula in the craniocervical junction do not have specificity, it can be diagnosed by performing encephalon angiography. Currently, microsurgery can generally find fistula and block it, and the efficacy is exact.

关 键 词：颅颈交界区 硬脑膜 动静脉瘘 显微外科手术 

分 类 号：R743.4[医药卫生—神经病学与精神病学]