出血性颅颈交界区硬膜动静脉瘘的血管结构分析及手术方式  

Angioarchitecture analysis and operation modes of hemorrhagic craniocervical junction dural arteriovenous fistula

作　　者：何川[1] 胡鹏[1] 叶明[1] 孙立泳 任健[1] 张鸿祺[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2016年第8期404-409,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨颅颈交界区硬膜动静脉瘘（CCJDAVF）的血管结构和手术方式。方法回顾性分析首都医科大学宣武医院神经外科2011年1月至2014年12月收治的21例出血性CCJDAVF并接受手术治疗患者的临床资料,包括病历记录、血管造影、手术录像和随访结果（9~45个月）。对20例行硬膜下引流静脉切断术,1例行硬膜下供血动脉切断术。其中7例行硬膜下引流静脉切断术＋动脉瘤介入栓塞术或外科切除术。结果 21例患者中,18例（85.7%）瘘口位于枕大孔/颈1节段,3例（14.3%）位于颈2节段;9例（42.9%）瘘口位于左侧,11例（52.4%）位于右侧,1例（4.8%）双侧均有瘘口。13例（61.9%）为单纯硬膜外的神经根动脉供血,8例（38.1%）存在硬膜下软膜供血,供血动脉为来自脊髓前动脉或脊髓侧动脉的软膜血管,其中7例硬膜下供血动脉出现软膜动脉瘤,并且破裂出血。对5例动脉瘤介入栓塞治疗,2例动脉瘤显微外科切除治疗。21例患者术后均康复,格拉斯哥预后评分均为5分,6个月复查DSA均无复发,随访均无再出血。结论 CCJDAVF可以存在硬膜下的软膜动脉供血,并形成软膜动脉瘤破裂出血。根据血管结构选择血管内治疗或手术切断供血动脉,能够有效防治再出血。Objective To investigate the angioarchiteeture and operation modes of craniocervical junction dural arteriovenous fistula （CCJDAVF）. Methods From January 2011 to December 2014, the clinical data of 21 patients with hemorrhagic CCJDAVF admitted to the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University and treated with surgery were analyzed retrospectively, including the medical records, angiography, surgery video, and follow-up results （ 9 -45 months）. Twenty patients received subdural drainage vein transection, 1 received subdural feeding artery transection. Seven of them received subdural drainage vein transection ＋ aneurysm interventional embolization or surgical resection. Results In 18 of 21 patients （85.7%） ,the fistulas were located at the foramen magnum or the C1 level ,in 3 patients （ 14.3% ） at the C2 level. In 9 of 21 patients （42.9%） ,the fistulas were at left side, in 11 patients （52.4%） at right side, in 1 patient （4.8%） at bilateral side. Feeders are only extradural radicular arteries in 13 patients （ 61.9% ） , 8 （ 38.1% ） had subdural blood supply. The feeding arteries came from the pial blood vessels of anterior spinal artery or lateral spinal artery,7 of them had pial artery aneurysms in subdural blood supply artery and they all ruptured. Five aneurysms were treated with aneurysm interventional embolization, and 2 aneurysms were treated with the microsurgical resection. All 21 patients recovered after procedure. All their Glasgow Outcome Scale scores were 5. No recurrence was observed on DSA at 6-month,and there was no rebleeding during the follow-up. Conclusions CCJDAVF may have subdural pial artery blood supply and form pial artery aneurysm rupture. Choosing endovascular treatment or surgical cutting off blood supply may effectively prevent and treat rebleeding according to the vascular structures.

关 键 词：脊髓血管畸形 颅颈交界区硬膜动静脉瘘 出血 治疗策略 

分 类 号：R651.1[医药卫生—外科学]