经岩上静脉引流的硬脑膜动静脉瘘的显微手术治疗  

Microsurgical management of dural arteriovenous fistulas draining into the superior petrosal veins

作　　者：邵灵敏[1] 陈刚[1] 简志宏[1] 刘仁忠[1] SHAO Ling-min;CHEN Gang;JIAN Zhi-hong;LIU Ren-zhong(Department of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院神经外科,武汉430060

出　　处：《中国临床神经外科杂志》2024年第11期641-645,共5页Chinese Journal of Clinical Neurosurgery

摘　　要：目的 探讨经岩上静脉引流的硬脑膜动静脉瘘的显微手术方法及疗效。方法 回顾性分析2014年1月至2022年12月采用显微手术治疗的10例经岩上静脉引流的硬脑膜动静脉瘘的临床资料。结果 术前脑血管造影确诊左侧岩上静脉引流3例,右侧7例。10例均采用枕下乙状窦后入路,术中经荧光造影确认后成功阻断瘘口及岩上静脉。术后因脑积水行脑室-腹腔分流术2例。术后半年,9例复查脑血管造影显示瘘口完全闭塞;临床随访6~36个月,按GOS评分:恢复良好8例,中残1例,重残1例。结论 枕下乙状窦后入路能够充分暴露岩上静脉,术前影像模拟及术中荧光造影准确定位瘘口是提高手术疗效的关键。Objective To investigate the microsurgical methods and clinical outcomes of patients with dural arteriovenous fistulas(DAVFs)draining into the superior petrosal veins(SPVs).Methods A retrospective analysis was carried out on the clinical data of 10 patients with DAVFs draining into the SPVs who underwent microsurgery from January 2014 to December 2022.Results Preoperative cerebral angiography confirmed that 3 cases were drained through the left superior petrosal vein and 7 through the right.All patients adopted the suboccipital retrosigmoid approach.The fistula and the superior petrosal vein were successfully blocked after confirmation through intraoperative fluorescence angiography.Two cases underwent ventriculoperitoneal shunt due to hydrocephalus after the operation.Six months after the operation,cerebral angiography reexamination showed that the fistulas were completely occluded in 9 cases.The clinical follow-up ranged from 6 to 36 months.According to the GOS score:8 cases had good recovery,1 case had moderate disability,and 1 case had severe disability.Conclusion The suboccipital retrosigmoid approach can fully expose the superior petrosal vein.Combining preoperative image simulation and intraoperative fluorescence angiography for accurate localization of the fistula is the key to improving the surgical outcome for patients with DAVFs draining into the SPVs.

关 键 词：硬脑膜动静脉瘘 岩上静脉 显微手术 枕下乙状窦后入路 疗效 

分 类 号：R743[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]