颅颈交界区髓周动静脉瘘患者血管构筑特点及治疗策略分析  

Analysis of angioarchitecture characteristics and treatment strategies in patients with craniocervical junction perimedullary arteriovenous fistulas

作　　者：马永杰[1] 宋子豪 叶明[1] 何川[1] 胡鹏[1] 孙力泳[1] 张鸿祺[1] Ma Yongjie;Song Zihao;Ye Ming;He Chuan;Hu Peng;Sun Liyong;Zhang Hongqi(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2023年第5期298-306,343,共10页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(82101460)。

摘　　要：目的探究颅颈交界区髓周动静脉瘘(PAVF)的血管构筑特点及治疗策略。方法回顾性连续纳入2012年1月至2021年12月于首都医科大学宣武医院神经外科住院诊疗的颅颈交界区动静脉瘘成年患者177例,均经DSA及术中所见确诊。依据颅颈交界区动静脉瘘的分型,将所有患者分为PAVF组(14例)和非PAVF组(163例)。记录并分析两组患者一般资料[性别、年龄、起病症状、住院前改良Rankin量表(mRS)评分]、血管构筑[瘘口节段(枕骨大孔、颈1节段、颈2节段)、动静脉瘘侧别(左、右、双侧)、供血动脉(椎动脉硬膜支、神经根动脉、脊髓前动脉、脊髓侧动脉、咽升动脉、枕动脉、小脑后下动脉、脑膜后动脉、脑膜中动脉)、引流静脉方向(硬膜内向上引流、硬膜内向下引流、向硬膜外引流)、伴动脉瘤样结构、伴引流静脉曲张等]、治疗方式(保守治疗、显微手术、介入栓塞、介入栓塞+显微手术)、并发症(脑脊液漏、颅内感染、肺部感染、脑积水、脑梗死、脊髓梗死、颅神经麻痹、下肢静脉血栓形成、椎动脉闭塞等)、复发、随访(分别于出院后1、3、6、12个月进行临床随访,以出院后1年的mRS评分为最终结果)的差异。mRS评分<3分为预后良好,mRS评分≥3分为预后不良,其中mRS评分6分为死亡。结果(1)颅颈交界区动静脉瘘成年患者177例中起病症状有蛛网膜下腔出血(SAH)92例、静脉高压脊髓病(VHM)80例、面肌痉挛2例和颅内杂音3例。PAVF组患者中,男9例,女5例;年龄39~76岁,平均(56±11)岁;以SAH起病12例,以VHM起病2例。两组患者年龄及性别、起病症状、住院前mRS评分占比的差异均无统计学意义(均P>0.05)。(2)14例PAVF组患者均为单发动静脉瘘(共14个),163例非PAVF组有8例为双侧瘘(共171个)。PAVF组与非PAVF组动静脉瘘个数在瘘口节段分布的差异有统计学意义(χ^(2)=11.878,P=0.003);PAVF组患者伴椎动脉硬膜支供血、伴�Objective To investigate the angioarchitecture characteristics and treatment strategies of craniocervical junction perimedullary arteriovenous fistulas(PAVF).Methods A total of 177 adult patients with craniocervical junction arteriovenous fistula(AVF)diagnosed and treated in the Neurosurgery Department of Xuanwu Hospital,Capital Medical University from January 2012 to December 2021 were retrospectively included.Craniocervical junction AVF was diagnosed by DSA and surgery.According to the classification of craniocervical junction AVF,all patients were divided into PAVF group(14 patients)and non-PAVF group(163 patients).Record and analyze the general data(gender,age,onset of symptoms,modified Rankin scale[mRS]score before hospitalization),angioarchitecture(fistula segment[occipital foramen,cervical segment 1,cervical segment 2],AVF side[left,right,bilateral],feeding artery[dural branch of vertebral artery,radicular artery,anterior spinal artery,lateral spinal artery,ascending pharyngeal artery,occipital artery,posterior inferior cerebellar artery,posterior meningeal artery and middle meningeal artery],direction of draining veins[ascending intradural drainage,descending intradural drainage,epidural drainage],with aneurysmal structures,with draining veins varix,etc.),treatment modalities(conservative treatment,microsurgery,interventional embolization,interventional embolization combined with microsurgery),complications(cerebrospinal fluid leak,intracranial infection,pulmonary infection,hydrocephalus,cerebral infarction,spinal cord infarction,cranial nerve palsy,lower-limb deep venous thrombosis,vertebral artery occlusion,etc.),recurrence,follow-up(clinical follow-up was carried out at 1,3,6,12 months after discharge,and the final result was the mRS score of 1 year after discharge).The mRS score<3 was good prognosis,mRS score≥3 was poor prognosis,and mRS score 6 was death.Results(1)Among 177 adult patients with AVF in craniocervical junction area,the onset symptoms included subarachnoid hemorrhage(SAH)in 92 cases,ve

关 键 词：动静脉瘘 颅颈交界区 髓周动静脉瘘 血管构筑 治疗策略 

分 类 号：R651.1[医药卫生—外科学]