头皮动静脉瘘五例并文献复习  

Scalp arteriovenous fistula:report of five cases and literature review

作　　者：赵常发 买买提力·艾沙[1] 卡合尔曼·卡德尔[1] 阿迪力江·艾则孜 程鹏 杜郭佳[1] Zhao Changfa;Maimaitili Aisha;Kaheerman Kadeer;Adilijiang Aizezi;Cheng Peng;Du Guojia(Department of Neurosurgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院神经外科,乌鲁木齐830054

出　　处：《中国脑血管病杂志》2022年第2期116-121,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：新疆维吾尔自治区创新环境(人才、基地)建设专项--天山青年计划项目(2020Q040)。

摘　　要：目的探讨头皮动静脉瘘的诊断方法及治疗特点。方法回顾性分析新疆医科大学第一附属医院神经外科2015年4月至2021年8月连续收治的5例头皮动静脉瘘患者的病历资料,对其临床特点、治疗方式、预后等进行评价。采用临床症状结合影像学检查结果进行疗效评估。术后即刻行头颈部CT血管成像或DSA检查,并术后3个月经门诊或电话随访,了解患者术后症状及并发症发生情况等。若术后即刻行CT血管成像或DSA检查显示头皮动静脉瘘已完全消失,患者症状明显改善,且门诊或电话随访时症状无复发视为完全治愈。结果5例患者均表现为头皮下搏动性包块进行性增大,其中2例有明确外伤史(1例饮酒摔倒后枕部皮下包块3年,1例外伤后出现左侧额颞部皮下肿物4年),1例为医源性损伤(左侧额顶部静脉滴注后出现额顶部包块13年),2例患者否认外伤,均为体格检查发现(头皮下肿物6年)。4例患者选择外科手术切除头皮动静脉瘘治疗,1例患者选择栓塞+手术切除治疗。5例患者术后均完全治愈,术后分别随访1年、3个月、2年、6年、4年,5例患者一般情况可,症状无复发。结论手术切除是治疗头皮动静脉瘘的首选治疗方法。术前仔细识别血管结构特征有助于成功治疗头皮动静脉瘘。Objective To discuss the diagnosis and treatment characteristics of scalp arteriovenous fistula.Methods The case data of 5 patients with scalp arteriovenous fistula admitted to the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University from April 2015 to August 2021 were retrospectively analyzed,and their clinical characteristics,treatment methods,and prognosis were evaluated.Clinical symptoms and imaging results were used to evaluate the efficacy.CT angiography of the head and neck or DSA examination was performed immediately after surgery,and the patient was followed up by outpatient visit or telephone for 3 months after surgery for the postoperative symptoms and complications.The patient is considered to be completely cured if CT angiography or DSA examination immediately after surgery shows that scalp arteriovenous fistula has completely disappeared,symptoms significantly improved,and no recurrence of symptoms in outpatient or telephone follow-up.Results Five patients were characterized by progressive increase of pulsatile mass under the scalp,of which 2 cases have a clear history of trauma(1 case of occipital subcutaneous mass for 3 years after fall due to drinking,and 1 case of left frontal temporal subcutaneous mass after trauma for 4 years),1 cases of iatrogenic injury(left frontal forehead mass after intravenous drip for 13 years),and 2 cases without trauma and were found during physical examination(subscalp mass for 6 years).Chose surgical resection was performed in four patients,and chose embolization+surgical resection was performed in 1 patient.All 5 patients were completely cured after the operation,and were followed up for 1 year,4 months,2 years,6 years,and 4 years,respectively.The general condition was acceptable and there was no recurrence.Conclusions Surgical resection is the first choice for the treatment of scalp arteriovenous f istula.Careful identification of vascular structural features before surgery can help successfully treat scalp arteriovenous fistu

关 键 词：动静脉瘘 脑损伤 栓塞 治疗性 手术切除 

分 类 号：R743[医药卫生—神经病学与精神病学]