舌下神经管区硬脑膜动静脉瘘的诊断与治疗  

Diagnosis and treatment of dural arteriovenous fistulas of the hypoglossal canal

作　　者：徐修鹏[1] 李征[1] 林超[1] 陈骅[1] 路华[1] XU Xiupeng;LI Zheng;LIN Chao;CHEN Hua;LU Hua(Department of Neurosurgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院神经外科,南京210029

出　　处：《临床神经外科杂志》2024年第5期558-561,567,共5页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金青年项目(82203767);江苏省自然科学基金青年项目(BK20201077)。

摘　　要：目的探讨舌下神经管区硬脑膜动静脉瘘的临床特点、诊断及治疗策略。方法回顾性分析2018年1月-2022年6月南京医科大学第一附属医院神经外科收治的5例舌下神经管区硬脑膜动静脉瘘(HCDAVFs)患者的临床资料。将Onyx-18闭塞瘘口及引流静脉近端定义为栓塞成功。术后10~15个月进行影像学和临床随访。结果5例患者中,搏动性耳鸣1例,突眼与球结膜水肿2例,蛛网膜下腔出血(SAH)1例,眩晕及后颈部不适1例。所有患者均接受血管内介入治疗,其中3例患者经静脉途径栓塞,2例患者经动脉途径栓塞。术后即刻造影结果提示所有患者均完全栓塞,无手术并发症发生。临床随访提示术后5例患者症状均得到缓解,影像学随访结果显示所有患者均未复发。结论血管内介入治疗是治疗HCDAVFs安全、有效的治疗方式。根据HCDAVFs血管构筑特点选择合理的栓塞路径是治疗成功的关键。Objective To explore the clinical characteristics,diagnosis and treatment strategies of dural arteriovenous fistulas of the hypoglossal canal(HCDAVFs).Methods The clinical data of 5 HCDAVFs patients who underwent endovascular treatment in the Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University from January 2018 to June 2022 were analyzed retrospectively.The occlusion of fistulas and proximal draining veins with Onyx-18 was defined as successful embolization.The postoperative imaging and clinical follow-up ranged from 10 to 15 months.Results Among them,1 presented with pulsating tinnitus,2 displayed proptosis and chemosis,1 exhibited subarachnoid hemorrhage(SAH)and 1 suffered from dizziness and discomfort in the posterior neck.All patients received endovascular treatment,among them 3 underwent transvenous embolization and 2 underwent transarterial embolization.Immediately after procedure,angiography revealed that all patients were completely embolized with no complications occurred.The clinical follow-up showed that the postoperative symptoms of 5 patients were relieved,and imaging follow-up results demonstrated that no recurrence occurred in all patients.Conclusions Endovascular treatment for HCDAVFs is safe and effective.Choosing a reasonable embolic approach based on the angioarchitecture of HCDAVFs is the key of successful treatment.

关 键 词：硬脑膜动静脉瘘 舌下神经管 血管内治疗 栓塞 

分 类 号：R743[医药卫生—神经病学与精神病学]