手术治疗颅颈交界区硬膜动静脉瘘的疗效分析  

Surgical outcomes of dural arteriovenous fistulas involving the craniocervical junction

作　　者：陈鑫璞[1] 白亚辉[1] 刘建新 王凯[1] 孙红卫[1] 刘献志[1] Chen Xinpu;Bai Yahui;Liu Jianxin;Wang Kai;Sun Hongwei;Liu Xianzhi(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450000

出　　处：《中华神经外科杂志》2023年第7期679-682,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨显微外科手术治疗颅颈交界区硬膜动静脉瘘(DAVF)的手术疗效和临床经验。方法回顾性分析2020年5月至2022年4月郑州大学第一附属医院神经外科采用显微外科手术治疗的10例颅颈交界区DAVF患者的临床资料。所有瘘口均位于枕大孔下缘至颈1椎体之间。其中神经根硬膜动脉供血8例,神经根硬膜动脉及脊髓外侧动脉供血2例;静脉向头侧引流6例,向颈侧引流4例。采用显微外科手术夹闭瘘口或电凝切断瘘口的方法,术中造影确认动静脉瘘口是否消失。术后3个月进行临床及影像学随访,通过与术前临床症状比较评价手术效果。结果10例患者术后即刻均达到影像学治愈,切口愈合良好,无脑脊液漏。术后症状减轻8例,加重1例,未改善1例。2例患者术后出现高热、头痛,经对症处理后症状消失。术后3个月,症状明显改善1例,症状消失8例;另1例患者症状无改善,数字减影血管造影显示动静脉瘘复发。结论采用显微外科手术治疗颅颈交界区DAVF安全、有效,明确瘘口及所有供血动脉是手术成功的关键。Objective To explore the therapeutic effect and clinical experience of microsurgery in the treatment of craniocervical junction dural arteriovenous fistulas(DAVF).Methods The clinical data of 10 patients with craniocervical junction DAVF treated by microsurgery in the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University from May 2020 to April 2022 were retrospectively analyzed.All fistulas were located between the lower edge of the foramen magnum and the cervical 1 vertebral body.The lesion was supplied by radiculo-meningeal artery in 8 cases and by radiculo-meningeal artery and lateral spinal artery in 2 cases.The lesion was drained by vein to the head side in 6 cases and drained to the neck side in 4 cases.Microsurgery was used to clip the fistula or cut off the fistula by electrocoagulation,and intraoperative angiography confirmed the disappearance of the DAVF.Clinical and imaging follow-up was carried out 3 months after operation,and the surgical effect was evaluated by comparing with preoperative clinical symptoms.Results All 10 patients achieved imaging cure immediately after surgery with good incision healing,and there was no cerebrospinal fluid leakage.Postoperative symptoms were relieved in 8 cases,aggravated in 1 case,and not improved in 1 case.Two patients developed high fever and headache after operation,and the symptoms disappeared after symptomatic treatment.During the 3-month follow-up,1 patient′s symptoms improved significantly,and 8 patients′symptoms disappeared;the other patient′s symptoms did not improve,and DSA showed recurrence of DAVF.Conclusions Microsurgical treatment of craniocervical junction DAVF is safe and effective.The key to the success of surgery is to identify the fistula and all the supplying arteries.

关 键 词：动静脉瘘 硬膜 显微外科手术 颅颈交界区 

分 类 号：R651.12[医药卫生—外科学]