静脉高压性脑干水肿的诊断与治疗  

Diagnosis and treatment of venous hypertensive brain stem congestion

作　　者：马永杰[1] 李桂林[1] 洪韬[1] 孙力泳[1] 张鸿祺[1] MA Yong-jie;LI Gui-lin;HONG Tao(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科

出　　处：《中国临床新医学》2019年第6期588-591,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：国家自然科学基金资助项目(编号:81671202)

摘　　要：目的探讨以静脉高压性脑干水肿起病的硬脑(脊)膜动静脉瘘的临床表现及诊疗策略。方法回顾分析2014-08~2015-08就诊于首都医科大学宣武医院神经外科的5例表现为静脉高压性脑干病变的硬脑(脊)膜动静脉瘘患者资料,包括病史、影像学、治疗情况和随访资料。结果5例患者病因包括2例岩上窦区硬脑膜动静脉瘘(DAVF),1例舌下神经管区DAVF,1例颅颈交界区DAVF,1例颈段硬脊膜动静脉瘘(SDAVF)。经栓塞治疗1例,显微外科手术4例。术后均经数字减影血管造影(DSA)复查明确瘘口消失,磁共振成像(MRI)复查可见脑干水肿缓解,患者症状体征均得到不同程度改善。结论静脉高压性脑干水肿病变严重,由硬脑(脊)膜动静脉瘘引起,临床症状并无特异性,MRI及DSA检查具有诊断价值。Objective To explore the clinical manifestation,diagnosis and treatment strategies of venous hypertensive brain stem congestion caused by spinal or cerebral dural arteriovenous fistula.Methods The data of five patients manifested as venous hypertensive encephalopathy treated in Xuanwu Hospital between August 2014 and August 2015 were reviewed retrospectively,including their medical history,neuroimagings,treatment and follow-up data.Results The five cases included 2 cases of superior petrosal sinus dural arteriovenous fistula(DAVF),1 case of hypoglossal canal DAVF,1 case of craniocervical junction DAVF and a case of a cervical spinal dural arteriovenous fistula(SDAVF).Four patients underwent microsurgical treatment while 1 got embolization.Postoperative digital substraction angiography(DSA)confirmed the obliteration of the fistulas and magnetic resonance imaging(MRI)indicated the remission of the congestion.All the patients had clinical improvements in various degress.Conclusion The brain stem venous hypertensive congestion caused by spinal or cerebral dural arteriovenous fistula is a severe disease.Its clinical symptoms are not specific,and MRI and DSA are of great value for diagnosis.

关 键 词：静脉高压 脑干水肿 动静脉瘘 诊断 治疗 

分 类 号：R742[医药卫生—神经病学与精神病学]