复合手术治疗颅内复杂动静脉瘘三例  

Hybrid surgery for complex symptomatic intracranial fistulas：a technical note

作　　者：张轶群 仇汉诚 陶冶飞 刘妙林 叶迅[2] 陈晓霖[2] 姜卫剑 

机构地区：[1]解放军火箭军总医院新纪元脑卒中医疗救治研究中心,北京100088 [2]首都医科大学附属北京天坛医院神经外科

出　　处：《中华医学杂志》2017年第11期822-826,共5页National Medical Journal of China

摘　　要：目的探讨复合手术治疗颅内复杂动静脉瘘的临床效果。方法2014年3月至2015年1月解放军火箭军总医院在神经血管疾病复合手术室内采用复合手术治疗颅内复杂动静脉瘘3例，其中硬脑膜动静脉瘘2例，颈内动脉海绵窦瘘1例。3例患者均为复杂病变，转至解放军火箭军总医院前曾在多家外院治疗效果不佳。3例均曾尝试单纯血管内治疗，入路困难转为复合手术。2例开颅后经脑膜支动脉入路，1例开颅直视下穿刺左侧海绵窦。结果术后即刻造影提示2例完全栓塞，1例大部分栓塞。3例均无手术并发症发生。出院时2例表现为无症状，1例表现为症状有所改善。随访1～33个月，1例在术后21个月复发，行栓塞术治疗后完全栓塞。结论在神经血管疾病复合手术室条件下，复合手术是治疗复杂颅内动静脉瘘大有前景的选择。ObjectiveTo explore the efficacy of hybrid management of complex symptomatic intracranial fistulas in neurovascular hybrid operating room. MethodsFrom March 2014 to January 2015, 2 complex dural arteriovenous fistulas and 1 carotid cavernous fistulas were managed by hybrid surgeries in the PLA Rocket Force General Hospital.With first attempts with endovascular treatment failed, all cases were finally managed by hybrid surgery.Dural arteriovenous fistulas were approached via meningeal artery followed craniotomy.The carotid cavernous fistulas were treated by direct puncture into the left cavernous sinus after craniotomy. ResultsPost-operative angiography demonstrated complete occlusion for 2 cases and nearly complete occlusion for 1 case.All 3 cases had no complications.On discharge 2 patients presented no symptoms and 1 greatly improved.Within the follow-up （1-33 months）, 1 patient had recurrence after 21 months and received re-embolization with complete occlusion. ConclusionHybrid surgery is a promising method to manage complex intracranial fistulas.

关 键 词：硬脑膜动静脉瘘 颈内动脉海绵窦瘘 复合手术 复杂病变 

分 类 号：R651.12[医药卫生—外科学]