血管内治疗小脑幕区硬脑膜动静脉瘘的疗效观察  

Observation of therapeutic effect of endovascular treatment of tentorial dural arteriovenous fistula

作　　者：赵常发 杜郭佳[1] 阿迪力江·艾则孜 苏日青[1] 成晓江[1] 买买提力·艾沙[1] Zhao Changfa;Du Guojia;Adilijiang·Aizezi;Su Riqing;Cheng Xiaojiang;Maimaitili·Aisha(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：《中华神经外科杂志》2022年第10期1051-1055,共5页Chinese Journal of Neurosurgery

摘　　要：目的观察血管内治疗小脑幕区硬脑膜动静脉瘘(TDAVF)的临床疗效。方法回顾性分析2015年3月至2021年6月新疆医科大学第一附属医院神经外科收治的28例TDAVF患者的临床资料。8例术前合并蛛网膜下腔出血。其中经动脉入路采用Glubran胶栓塞9例、采用Onyx胶栓塞17例,采用Onyx胶经动脉入路联合经静脉入路球囊辅助栓塞2例。观察疗效及手术相关并发症。结果28例患者中,TDAVF完全栓塞22例,次全栓塞2例,部分栓塞1例,栓塞失败3例。1例因Glubran胶反流导致右侧小脑半球亚急性梗死。28例患者的中位随访时间为34个月(5个月至6年)。19例患者的症状明显改善,包括13例治愈(症状消失)和6例症状好转的患者,其余9例患者的症状较术前无明显变化。行数字减影血管造影随访的15例患者均未见TDAVF复发。结论血管内治疗TDAVF疗效较好,手术风险较低。Objective To observe the clinical effect of endovascular treatment of tentorial dural arteriovenous fistula(TDAVF).Methods The clinical data of 28 patients with TDAVF admitted to the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University from March 2015 to June 2021 were retrospectively analyzed.Eight patients were diagnosed as subarachnoid hemorrhage prior to operation.Among them,9 cases underwent embolization with Glubran glue through arterial approach,17 cases underwent embolization with Onyx glue,and 2 cases underwent embolization with Onyx glue through arterial approach combined with transvenous balloon-assisted embolization.The therapeutic effect and operation-related complications were documented.Results Among the 28 patients,22 had complete embolization,2 had subtotal embolization,1 had partial embolization,and 3 had failed embolization.There was 1 case of subacute infarction of the right cerebellar hemisphere due to the Glubran glue reflux.The follow-up time was 5 months to 6 years,and the median follow-up time was 34 months.The symptoms of 19 patients were significantly improved,including 13 patients who were cured(symptoms disappeared)and 6 patients whose symptoms improved,and the symptoms of the remaining 9 patients did not change significantly compared with those before surgery.No recurrence was found in the 15 patients who underwent DSA follow-up.Conclusion Endovascular treatment of TDAVF has relatively favorable therapeutic effect and few surgical risks.

关 键 词：动静脉瘘 血管内操作 硬脑膜 小脑幕 

分 类 号：R651.1[医药卫生—外科学]