不同血管入路栓塞前颅窝硬脑膜动静脉瘘的有效性和安全性分析  

Efficacy and safety of neurointervention in anterior cranial fossa dural arteriovenous fistula:a comparative analysis of different vascular approaches

作　　者：龚文智 李灿 冯欣 刘文超[1] 葛润泽 黄驰 黄际万 李然[1] 郭慎全 段传志[1] 李西锋[1] Gong Wenzhi;Li Can;Feng Xin;Liu Wenchao;Ge Runze;Huang Chi;Huang Jiwan;Li Ran;Guo Shenquan;Duan Chuanzhi;Li Xifeng(National Key Clinical Specialty,Engineering Research Center of Diagnostic and Therapeutic Technology and Devices for Cerebrovascular Diseases in Ministry of Education,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration,Zhujiang Hospital Institute for Brain Science and Intelligence,Department of Cerebrovascular Surgery,Neurosurgery Center,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China)

机构地区：[1]南方医科大学珠江医院神经外科中心脑血管病外科,国家临床重点专科,脑血管病诊疗技术与器械教育部工程研究中心,广东省普通高校脑功能修复与再生重点实验室,脑科学与脑智能研究院,广州510282

出　　处：《中华神经医学杂志》2025年第3期224-229,共6页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(82271297);国家卫生健康委能力建设和继续教育中心基金(GWJJ2022100102)。

摘　　要：目的探讨不同血管入路栓塞前颅窝硬脑膜动静脉瘘(ACF-DAVF)的有效性和安全性,为ACF-DAVF的个体化治疗提供参考。方法回顾性选择南方医科大学珠江医院神经外科中心脑血管病外科自2020年1月至2023年12月收治的25例ACF-DAVF患者为研究对象。术中根据ACF-DAVF的血管构筑特征及微导管超选的难易程度,选择经大脑前动脉(7例)、面动脉(3例)、脑膜中动脉(8例)、眼动脉(6例)和静脉(1例)入路行栓塞治疗。术后即刻采用DSA检查明确瘘口及引流静脉近端栓塞情况,并观察围手术期并发症发生情况。术后6个月时采用改良Rankin量表(mRS)评估患者的预后,并行DSA或MRA检查明确ACF-DAVF有无复发。结果经脑膜中动脉入路患者术后即刻瘘口及引流静脉近端完全栓塞6例,近全栓塞2例;经眼动脉入路患者完全栓塞4例,近全栓塞2例;经大脑前动脉入路患者完全栓塞6例,近全栓塞1例;经面动脉入路患者完全栓塞3例;经静脉入路患者完全栓塞1例。所有患者围手术期均无颅内出血、视网膜中央动脉闭塞等并发症发生。术后6个月时临床随访25例,mRS评分0分19例,1分2例,2分4例;DSA随访19例,MRA随访6例,均显示无ACF-DAVF复发。结论基于ACF-DAVF的血管构筑特征及微导管超选的难易程度,个体化选择血管入路栓塞ACF-DAVF可获得较好的有效性和安全性。ObjectiveTo explore the efficacy and safety of embolization of anterior cranial fossa dural arteriovenous fistula(ACF-DAVF)via different arterial approaches,and provide evidence for individualized treatment of ACF-DAVF.MethodsA retrospective study was performed;25 patients with ACF-DAVF admitted to Department of Cerebrovascular Surgery,Neurosurgery Center,Zhujiang Hospital,Southern Medical University from January 2020 to December 2023 were enrolled.Vascular approaches,including the anterior cerebral artery(n=7),facial artery(n=3),middle meningeal artery(n=8),ophthalmic artery(n=6),and vein(n=1),were selected based on angioarchitectural features and microcatheter accessibility.Fistula and proximal draining vein occlusions were confirmed by immediate post-embolization digital subtraction angiography(DSA),and perioperative complications were recorded.At a 6-month follow-up,prognoses were assessed by modified Rankin Scale(mRS),and DSA or MRA was performed to detect the recurrence of ACF-DAVF.ResultsSix patients had complete embolization and 2 patients had near-total embolization of the fistula and proximal draining vein immediately after embolization via middle meningeal artery approach;4 patients achieved complete embolization and 2 patients achieved near-total embolization via ophthalmic artery approach;6 patients achieved complete embolization and one patient achieved near-total embolization via anterior cerebral artery approach;3 patients achieved complete embolization via facial artery approach;one patient achieved complete embolization via venous approach.No perioperative intracranial hemorrhage or central retinal artery occlusion was noted.Follow-up for 6 months was performed in 25 patients:mRS score was 0 in 19 patients,1 in 2 patients,and 2 in 4 patients;DSA in 19 patients and MRA in 6 patients indicated no ACF-DAVF recurrence.ConclusionBased on the angioarchitectural features and microcatheter accessibility,individualized selection of vascular approaches for ACF-DAVF embolization can achieve better efficacy

关 键 词：硬脑膜动静脉瘘 前颅窝 神经介入 

分 类 号：R651[医药卫生—外科学] R743[医药卫生—临床医学]