三维数字减影血管造影在颅颈交界区硬脑膜动静脉瘘手术中的作用  

Role of three-dimensional digital subtraction angiography in surgery of craniocervical junction dural arteriovenous fistulas

作　　者：佟献增 叶明[2] Tong Xianzeng;Ye Ming(Department of Neurosurgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院神经外科,100050 [2]首都医科大学宣武医院神经外科

出　　处：《中国脑血管病杂志》2022年第3期190-197,共8页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨三维DSA(3D DSA)在颅颈交界区硬脑膜动静脉瘘(CCJDAVF)手术中的作用,并对手术预后进行总结。方法回顾性纳入2019年2月至2021年11月于首都医科大学附属北京友谊医院神经外科(2例)和首都医科大学宣武医院神经外科(14例)经第一作者主刀或第一作者与通信作者共同主刀行显微外科手术切断瘘口的CCJDAVF患者16例(共17个动静脉瘘)。术前表现为蛛网膜下腔出血6例;非出血性病例10例,其中9例因脑干和(或)颈髓水肿表现为脑干和(或)颈髓功能障碍,1例因静脉瘤压迫颈部神经表现为颈肩部疼痛。本组患者均在术前行DSA和3D DSA成像。通过3D DSA对CCJDAVF的血管构筑充分认识,包括供血动脉、瘘口位置、引流静脉的走行以及是否伴有动脉瘤或静脉瘤等。将3D DSA与颅颈交界区骨质的融合图像用于术前评估和手术计划。术后进行全脑血管造影,术前、术后以及术后1个月随访时对患者进行改良Rankin量表(mRS)评分评估。结果(1)影像学检查结果:3D DSA显示,16例中,1例供血动脉仅由咽升动脉硬膜支供血,余15例共16个CCJDAVF均由椎动脉脑膜支供血(其中1例同时由同侧枕动脉供血,1例同时由同侧咽升动脉供血,1例同时由脊髓前动脉软膜支供血并伴有动脉瘤样结构);11例瘘口位于齿状韧带的前方、椎动脉穿硬膜处周围,3例瘘口位于枕髁内上方硬膜下,2例由椎动脉发出的脑膜后动脉供血的CCJDAVF瘘口位于枕骨大孔后缘附近中线硬膜下;表现为蛛网膜下腔出血的CCJDAVF引流方向主要通过髓前静脉向上引流,表现为脑干和(或)颈髓水肿和神经功能障碍的CCJDAVF引流方向通过髓周静脉向下引流。(2)治疗及随访结果:16例患者瘘口均行电凝切断,术后出院前DSA检查示瘘口均消失,CCJDAVF不显影。术后1个月随访,15例患者mRS评分0~1分,1例mRS评分3分。结论3D DSA有助于对CCJDAVF的血管构筑进行更为直观的认识,并有�Objective To evaluate the role of three-dimensional digital subtraction angiography(3D DSA)in surgery of craniocervical junction dural arteriovenous fistula(CCJDAVF)and summarize the surgical prognosis.Methods From February 2019 to November 2021,16 patients with CCJDAVF(2 cases of the Department of Neurosurgery,Beijing Friendship Hospital,Capital Medical University and 14 cases of the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University)were treated with microsurgery performed by the first author(or the first author and the corresponding author).Six patients presented with subarachnoid hemorrhage(SAH).Ten patients presented with non-hemorrhagic symptoms,including 9 patients with congestive venous myelopathy due to edema of the brainstem and/or upper cervical cord,and 1 patient with neck and shoulder pain due to cervical neural compression by the venous varix.Preoperative DSA and 3D DSA were performed for all patients in this study.3D DSA was used to clearly visualize the angioarchitecture of the CCJDAVF,including the feeding artery,the fistulous site,the venous drainage and concomitant aneurysm or venous aneurysm.Image fusion of 3D DSA and the bone of the craniocervical junction was used for preoperative evaluation and surgical planning.Postoperative DSA was performed for all these patients after surgical disconnection of the fistula.Patient neurological status was evaluated with modified Rankin scale(mRS)score preoperatively,postoperatively and at one-month follow-up after microsurgery.Results(1)Radiological results:3D DSA showed that among the 16 patients,the ascending pharyngeal artery was the single feeding artery in one patient.For the other 15 patients with 16 CCJDAVFs,all were mainly fed by the meningeal branches of vertebral arteries,with concurrent feeding arteries including 1 with ipsilateral occipital artery,1 with ipsilateral ascending pharyngeal artery and 1 with the pial branch of anterior spinal artery(with aneurysmal structure).In 11 patients,the fistulous sites were located anter

关 键 词：血管造影术 数字减影 血管造影术 数字减影 三维 颅颈交界区硬脑膜动静脉瘘 显微手术 

分 类 号：R651.12[医药卫生—外科学]