表现为反复脑出血的小脑幕硬脑膜动静脉瘘1例并文献复习  

Bilateral basal ganglia hemorrhage due to tentorial dural arteriovenous fistula:a case report and systematic literature review

作　　者：温冰[1] 申杰[2] 马立华 郭斌[1] 刘艺鸣[1] 徐广润[1] 王潭[4] 王勤周[1] Wen Bing;Shen Jie;Ma Lihua;Guo Bin;Liu Yiming;Xu Guangrun;Wang Tan;Wang Qinzhou(Department of Neurology,Qilu Hospital,Shandong University,Jinan 250012,China;Department of Neurosurgery,Qilu Hospital,Shandong University,Jinan 250012,China;Department of Vertigo,Dongying People′s Hospital,Dongying 257091,China;Department of Geriatric Medicine,Qilu Hospital,Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院神经内科,济南250012 [2]山东大学齐鲁医院神经外科,济南250012 [3]东营市人民医院眩晕科,东营257091 [4]山东大学齐鲁医院老年医学科,济南250012

出　　处：《中华神经科杂志》2022年第2期109-116,共8页Chinese Journal of Neurology

基　　金：国家自然科学基金青年科学基金(81701058);山东省重点研发计划项目(2018GSF118059)。

摘　　要：目的探讨小脑幕硬脑膜动静脉瘘(TDAVF)所致脑出血的临床特点。方法报道1例2020年3月于山东大学齐鲁医院神经内科就诊的短期内先后发生双侧基底节区出血的TDAVF且合并高血压的患者,并对文献报道的TDAVF所致脑出血的病例特点进行总结分析。结果患者男性,33岁,经数字减影血管造影(DSA)检查发现幕孔区存在动静脉瘘,由右侧脑膜垂体干、双侧脑膜中动脉、大脑后动脉供血,经瘘口形成由脑膜静脉-上矢状窦或乙状窦两条途径引流。对患者行栓塞手术治疗,术后DSA见瘘口消失。随访1年,患者临床好转且未再出现脑出血。总结2021年3月30日前国内外报道的有临床和影像详细资料且表现为脑实质出血的TDAVF患者共41例,平均发病年龄为57.2岁,男女比例约3∶1。脑出血发生于幕上的患者17例(41%),幕下24例(59%)。幕上脑出血部位多集中在枕叶和丘脑。DSA检查显示该组患者中有36例(88%)动静脉瘘属于BordenⅢ型或CognardⅣ型。29例(71%)患者通过单一治疗方式达到瘘口闭合,另外12例(29%)患者采取多次介入或多种外科干预治疗。37例(90%)患者经DSA证实达到解剖治愈效果,39例(95%)患者病情好转预后良好。结论TDAVF可导致基底节区出血,应引起临床医生关注。伴有高血压患者发生脑出血的病因未必是高血压,需要积极筛查其他可能的病因,早期确诊和干预治疗对预防复发和改善预后具有极其重要的意义。Objective To investigate the clinical characteristics of cerebral hemorrhage caused by tentorial dural arteriovenous fistula(TDAVF).Methods An unusual TDAVF case admitted to the Department of Neurology,Qilu Hospital,Shandong University in March 2020,complicated with hypertension with successive bilateral basal ganglia hemorrhage in short term was reported.The characteristics of cerebral hemorrhage caused by TDAVF reported in the literature were summarized and analyzed.Results Digital subtraction angiography(DSA)revealed that there was arteriovenous fistula in the tentorial foramen area of this patient(male,33 years old),and the TDAVF was fed by the right meningohypophyseal trunk,bilateral middle meningeal artery and posterior cerebral artery.A shunted pouch was present in the tentorial foramen area,and retrograde reflux drainage was seen in the deep venous system,from the meningeal vein to superior sagittal sinus or sigmoid sinus.Transarterial embolization was performed and subsequently DSA showed obliteration of the fistula.This patient experienced no clinical decline or rehemorrhage during the 12 months follow-up period.Forty-one cases of TDAVF with hemorrhage of cerebral parenchyma which were reported before March 30,2021 with detailed clinical and imaging data were summarized.The average age of onset of this group of patients was 57.2 years,and the ratio of male to female was about 3∶1.The hemorrhage was located in superior of the tentorium in 17 cases(41%),while in inferior of the tentorium in 24 cases(59%).Supratentorial intracerebral hemorrhage mainly occurred in occipital lobe and thalamus.DSA showed that the arteriovenous fistula was classified as Borden typeⅢor Cognard typeⅣin 36 cases(88%).Twenty-nine patients(71%)underwent a single surgical procedure,while 12 cases(29%)underwent combined surgical or other treatments.Overall,37 patients(90%)achieved angiographically documented obliteration of the fistula and 39 patients(95%)experienced good or excellent outcomes.Conclusions TDAVF often presents a

关 键 词：脑出血 动静脉瘘 血管造影术 数字减影 栓塞 治疗性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]