左侧椎动脉双支起源变异合并左侧颞顶叶AVM的诊治分析(附1例报道并文献复习)  

Diagnosis and treatment of patients with left tempo-parietal AVM associating with variation of the origin of left vertebral artery(report of one case and literature review)

作　　者：白三莉 孙荣辉 向伟楚 潘思源 沈春发 张少杰 杨铭 马廉亭 赵曰圆 潘力 BAI San-li;SUN Rong-hui;XIANG Wei-chu;PAN Si-yuan;SHEN Chun-fa;ZHANG Shao-jie;YANG Ming;MA Lian-ting;ZHAO Yue-yuan;PAN Li(Medical School,Wuhan University of Science and Technology,Wuhan 430065,China;Department of Neurosurgery,General Hospital of Central Theater Command,PLA,Wuhan 430070,China)

机构地区：[1]武汉科技大学医学院,武汉430065 [2]中国人民解放军中部战区总医院神经外科/中国人民解放军神经外科研究所/国家级重点学科神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2021年第11期845-848,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的总结左侧椎动脉双支起源变异合并左侧颞顶叶动静脉畸形(AVM)的诊治经验。方法回顾性分析1例左侧椎动脉双支起源变异合并左侧颞顶叶AVM的临床资料,并结合相关文献进行总结分析。结果20岁女性,因癫痫发作入院。头部MRI示左侧颞顶叶血管流空影。DSA示左侧颞顶叶AVM,由左侧大脑中动脉颞后支供血,经中央皮层静脉引流至上矢状窦;同时,发现左椎动脉双支起源变异,粗大的一支起源于弓上血管、在左锁骨下功脉与左颈总动脉起点之间,较细的一支起源于左侧锁骨下动脉第一段,两支于第五颈椎下缘汇合。全麻下行l8%ONYX胶栓塞治疗,出院时改良Rankin量表评分0分。术后1周复查头颈部CTA示畸形血管团大部分消失。结论椎动脉双支起源变异的病人临床罕见,合并AVM的病人则更少见。认识椎动脉起源变异,对合并此类变异的脑血管病的诊断、介入治疗入路选择及避免手术误伤变异椎动脉有较大指导价值。Objective To summarize the experience in diagnosis and treatment of the patients with left tempo-parietal arteriovenous malformation(AVM)associating with variation of the origin of left vertebral artery.Methods A retrospective analysis of the clinical data of one patient with left tempo-parietal AVM associating with variation of the origin of left vertebral artery,and the related literatures were reviewed.Results A 20-year-old female was admitted to our hospital due to epileptic seizures.Preoperative MRI showed vascular shadow in the left temporal and parietal lobes.Preoperative DSA showed AVM in the left temporal and parietal lobes,whose blood was supplied by the posterior temporal branch of the left middle cerebral artery and drained to the superior sagittal sinus through the central cortical vein.At the same time,DSA was found that the left vertebral artery had two branches of origin,of which the biger one stemed from the segment of upper arch between the left subclavian artery and the starting point of left common carotid artery,the smaller one stemed from the first segment of left subclavian artery,and the two branches merged at the lower edge of the fifth cervical vertebra.Under general anesthesia,the patient received 18%ONYX glue embolization,with a modified Rankin scale score of 0 at discharge.The head and neck CTA showed that most of AVM was disappeared 1 week after the operation.Conclusions Patients with with variation of the origin of left vertebral artery are clinically rare,and patients with such variation associating with AVM are more rare.Understanding the variation of the origin of left vertebral artery has great value in guidance for the diagnosis,choice of interventional treatment approach and avoidance of injury to the vertebral artery during surgery in the patients with cerebrovascular disease assocating with such variation.

关 键 词：脑动静脉畸形 椎动脉起源变异 血管内栓塞 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]