伴髓周静脉引流的岩尖区硬脑膜动静脉瘘诊治分析  

Diagnosis and treatment analysis of petrous apex dural arteriovenous fistula with perimedullary venous drainage

作　　者：李静伟[1] 李鹏[1] 杜世伟[1] 张鸿祺[1] 凌锋[1] 李桂林[1] Li Jingwei;Li Peng;Du Shiwei;Zhang Hongqi;Ling Feng;Li Guilin(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beifing 100053,China)

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》2018年第9期455-460,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划项目(2016YFC1301800)

摘　　要：目的探讨伴髓周静脉引流的岩尖区硬脑膜动静脉瘘(DAVF)的临床和影像学特点。方法回顾性连续性纳入2002年2月至2017年12月首都医科大学宣武医院神经外科收治的伴髓周静脉引流的岩尖区DAVF患者30例,均经DSA确诊。记录患者的临床表现、血管构筑、治疗方式及随访结果。结果 (1)30例患者中,男25例(83.3%),女5例(16.7%);发病年龄19～68岁,平均(50±12)岁;病程0.3～24.0个月,病程中位数为3.0(1.0,5.0)个月。首发症状中,脑干或高位颈髓水肿者28例(93.3%),蛛网膜下腔出血者2例(6.7%)。术前改良Rankin量表(mRS)评分为(3.7±1.1)分,Barthel日常生活能力指数(BI)评分为65.0(0.0,81.3)分。(2)来自颈内动脉的脑膜垂体干幕缘支(30例,100.0%)和来自颈外动脉的脑膜中动脉岩支(21例,70.0%)是岩尖区DAVF的主要供血动脉。(3)20例患者接受介入栓塞治疗,7例患者接受显微外科手术治疗,3例在部分栓塞后接受外科手术治疗。手术相关并发症3例(10.0%),其中2例为周围性面瘫,1例为栓塞术后第3天再出血,经治疗完全恢复;因呼吸衰竭死亡者2例(6.7%)。(4)28例完成随访,中位随访时间49.5(26.0,93.8)个月。随访时mRS和BI评分分别为(1.1±0.7)分和95.0(92.5,100.0)分,与术前评分比较,差异均有统计学意义(t=21.24,Z=-4.795,均P<0.05)。25例(83.3%)患者神经功能基本恢复正常(mRS评分≤1分,BI评分≥90分),3例(10.0%)患者遗留轻度神经功能障碍(mRS评分为2分,80分≤BI评分<90分)。结论伴髓周静脉引流的岩尖区DAVF患者多表现为脑干或高位颈髓水肿症状,具有较高的致死风险,但及时正确的治疗可使多数患者获得较好的预后。Objective To investigate the clinical and imaging features of petrous apex dural arteriovenous fistula（ DAVF） with perimedullary venous drainage. Methods From February 2002 to December 2017,30 consecutive patients with petrous apex dural DAVF diagnosed by digital subtraction angiography（ DSA） and admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. The clinical manifestations,vascular architecture,treatment modalities,and follow-up results of the patients were recorded. Results（ 1） Of the 30 patients,5 were females（ 16. 7%）and 25 were males（ 83. 3%）; the onset age ranged from 19 to 68 years,with an average age of 50 ± 12 years. The course of disease ranged from 0. 3 to 24. 0 months with a median of 3. 0（ 1. 0,5. 0） months. Among the first symptoms,28（ 93. 3%） had brain stem or high cervical spinal cord edema,and 2（ 6. 7%） had subarachnoid hemorrhage. The preoperative modified Rankin scale（ mRS） score was 3. 7 ± 1. 1,and Barthel index（ BI）score was 65. 0（ 0. 0,81. 3）.（ 2） The main supplying arteries of DAVF in petrous apex were the tentorial marginal branches of the meningohypophyseal trunk（ n = 30,100. 0%） from the internal carotid artery and the petrosal branches of the middle meningeal artery（ n = 21,70. 0%） from the external carotid artery.（ 3） Twenty patients received interventional embolization,7 received microsurgery,and 3 received surgical treatment after partial embolization. Three patients（ 10. 0%） had surgery-related complications,2 of them were peripheral facial paralysis,and 1 was rebleeding 3 days after embolization. They recovered completely after treatment. Two patients died of respiratory failure（ 6. 7%）.（ 4） Twenty-eight patients completed followup,the median follow-up time was 49. 5（ 26. 0,93. 8） months. At follow-up,the mRS and BI scores were 1. 1 ±0. 7 and 95. 0（ 92. 5,100. 0） respectively. Compared with the preoperative score,the difference was sta

关 键 词：硬脑膜动静脉瘘 岩尖区 脑干水肿 岩静脉 介入栓塞 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]