硬脑膜动静脉瘘患者颅内出血的危险因素分析

目的除了合并皮层静脉引流这一危险因素之外,目前尚无其他因素被公认是硬脑膜动静脉瘘（DAVF）患者颅内出血的独立危险因素。本研究的目的在于通过单因素和多因素分析,阐明DAVF患者颅内出血的危险因素。方法回顾分析2007年1月～2012年12月第二军医大学长海医院临床神经医学中心收治的190例DAVF患者。其中颅内出血60例,非出血表现130例。收集临床和影像学资料,提取人口学特征、临床表现类型、血管构筑学特征等参数,对比不同表现DAVF在上述参数上的差异,并进行Logistic回归分析。结果Logistic回归分析发现颅内出血发病的危险因素为瘘口位于大静脉窦区（OR4．296,95％CI：1．126-16．393,P=0．033）,Borden分级Ⅱ级（OR3．852,95％CI：1．123～13．207。P=0．032）和Ⅲ级（OR14．070．95％CI：2．741～72．237,P=0．002）。结论瘘口位于大静脉窦区,引流方式为BordenⅡ级和Ⅲ级是DAVF患者发生颅内出血的独立危险因素。     

手术治疗硬脑膜动静脉瘘患者预后状况的危险因素研究

目的：探讨手术治疗硬脑膜动静脉瘘患者预后危险因素。方法140例硬脑膜动静脉瘘患者分为预后良好组和预后不良组,收集其性别、年龄、瘘口位置、术前mRS、Borden分级、静脉窦血栓、手术入路方式、术后瘘口影像检查、主窦是否顺畅和术后随访等相关因素进行单因素方差分析。结果单因素方差分析显示2组间的术前m RS、静脉窦血栓、手术入路方式、术后瘘口影像检查、主窦是否顺畅的差异具有统计学意义（P＜0·05）,而性别、年龄、瘘口位置以及Borden分级的差异无统计学意义（P＞0·05）。结论术前神经功能损伤严重、联合入路手术方式、瘘口部分消除合并皮质静脉引流以及主窦不顺畅是影响硬脑膜动静脉瘘患者预后的独立危险因素。     

硬脑膜动静脉瘘向脊髓表面引流

本文对一种可引起进展性上行性脊髓病变的硬脑膜动静脉瘘(dural arteriovenous fistulas,DAVE)的一新类型,即硬脑膜动静脉瘘向脊髓表面引流(intracranial dural arteriovenous fistulas with spinal perimedullary venous drainage,ICDAVF-SPMVD)的临床表现、影像学、病理生理学和诊断治疗及分类归属等进行了综述。     

硬脑膜动静脉瘘

硬脑膜动静脉瘘是临床上常见的一种脑血管畸形,其发生机理极为复杂,临床表现多样,治疗有相当的难度。本文对硬脑膜动静脉瘘的发病机制、临床表现、诊断和治疗进行了综述。     

硬脑膜动静脉瘘发病机制的研究进展

硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)是指发生于硬脑膜动脉与硬脑膜静脉、脑静脉窦及皮质静脉间的异常动静脉吻合,属颅内血管畸形的范畴,占颅内血管畸形的10%～15%,幕上动静脉畸形的6%,幕下动静脉畸形的35%,可发生于硬脑膜的任何部位,但以海绵窦、横窦、乙状窦、上矢     

向脊髓引流的硬脑膜动静脉瘘诊治体会

目的探讨向脊髓表面引流的硬脑膜动静脉瘘（DAVF）的临床特点及治疗。方法回顾性分析2009年2月。2012年10月诊治的5例向脊髓引流DAVF患者的临床资料。4例单纯行栓塞治疗,1例行栓塞后手术切除。结果术后DSA示5例患者的瘘口均完全消失,达到解剖治愈。4例随访6个月-2年,肢体肌力及感觉均有一定恢复,MRI示脊髓表面迂曲血管流空影消失,DsA示瘘口消失、无复发。结论向脊髓引流的DAVF患者脊髓血管造影常显示正常,应注意行脑血管造影,避免漏诊、误诊,治疗主要以血管内栓寨为丰。     

硬脑膜动静脉瘘所致静脉高压性脑病

1病例简介患者,男,64岁,主因“反应迟钝,行动缓慢2年,发作性意识丧失6个月”,门诊以“颅内病变性质待查,症状性癫痫”于2006-01-25收入我院。现病史:患者2年前无明显诱因逐渐出现反应迟钝、行动缓慢,未予重视。6个月前,患者无明显诱因突然跌倒,伴意识丧失、二便失禁,当时有无四肢抽搐不详,症状自行缓解。     

小脑幕硬脑膜动静脉瘘向脊髓静脉引流1例报告

硬脑膜动静脉瘘向脊髓表面引流少见。目前献已报道258例，伴脊髓症状仅6例，同时存在颅神经症状更罕见。[第一段]     

硬脑膜动静脉瘘CT、MRI及DSA对比研究

目的对比研究硬脑膜动静脉瘘(DAVF)的CT、MRI及DSA影像学检查结果的差异,探索DAVF在不同影像学检查中的特征性表现。方法对98例不同类型DAVF的CT、MRI及DSA检查结果进行对比研究。结果CT及MRA检查能较好地显示因DAVF所致的颅内继发性病变,扩张的引流静脉,继发性出血及静脉窦狭窄、闭塞等改变;DSA检查则能准确地显示瘘口部位、供血动脉、静脉引流情况及颅内血流分布情况,但无法显示继发的脑实质病变。结论DSA检查是诊断DAVF的金标准。CT、MRA检查亦能为诊断DAFV提供可靠依据。     

经静脉途径栓塞32例硬脑膜动静脉瘘

目的探讨经静脉途径栓塞治疗硬脑膜动静脉瘘的临床效果。方法对32例硬脑膜动静脉瘘患者行经静脉途径栓塞治疗，其中海绵窦区22例，侧窦区10例，通过脑血管造影及临床随访来评价临床疗效。结果术后即刻造影示瘘口完全闭塞19例，瘘口处血流速度明显减慢13例。9例患者术后眼球突出、结膜水肿一过性加重。随访3月～2年，临床症状消失21例，症状明显缓解11例。结论经静脉途径栓塞治疗硬脑膜动静脉瘘患者是一种有效的疗法。     

Progressive subcortical calcifications secondary to venous hypertension in an intracranial dural arteriovenous fistula

Intracranial dural arteriovenous fistulas (dAVF) are acquired lesions, with the most commonly reported findings on CT haemorrhage or focal oedema. We describe a case of progressive subcortical calcification on CT secondary to venous hypertension from a high grade dAVF.     

Risk factors for dural arteriovenous fistula intracranial hemorrhage

To our knowledge, the risk factors for intracranial hemorrhage from dural arteriovenous fistula (DAVF) have not been systematically described, due to the complexity of their anatomy and low incidence. We performed this retrospective study to investigate the DAVF factors predicting intracranial hemorrhage. A 10 year database of 144 consecutive patients with DAVF was reviewed. Data collected and analyzed were demographics, morphologic features of DAVF, sex, age, fistula flow rate, arterial supply, lesion location, and venous drainage pattern. Linear univariate and multivariate logistic regression analyses were used to evaluate the association between influencing factors and hemorrhage. A first linear univariate analysis was performed for all influencing factors, and showed that sex, lesion location, and venous drainage pattern were statistically significant in predicting intracranial hemorrhage (p < 0.05). Secondary multivariate logistic regression analysis with sex, lesion location, and venous drainage pattern showed that only venous drainage pattern was statistically significant in predicting intracranial hemorrhage (p < 0.05). Therefore, venous drainage pattern, particularly the cortical venous drainage, significantly predicts intracranial hemorrhage from DAVF. Both sex and lesion location may be confounding factors in predicting intracranial hemorrhage from DAVF, while the other factors may not be associated with hemorrhage.     

Surgical treatment of high grade dural arteriovenous fistulae

Dural arteriovenous fistulae (dAVF) with direct cortical venous drainage (CVD, Borden Type III) have a high risk of hemorrhage, particularly when symptomatic. Stereotactic radiosurgery is therefore not recommended, and endovascular treatment can be limited by access, incomplete obliteration, and recanalization. Of 70 cerebral dAVF seen at our institution over the past 8 years, 35 were Borden Type III (50%). Twenty-four were treated via microsurgery (69%). Presentation included hemorrhage in nine patients (38%), nonhemorrhagic neurologic deficits in five (21%), asymptomatic in five (21%), headache in three (13%), and seizure in two patients (8%). Only eight of 19 patients with symptomatic dAVF were independent (modified Rankin Scale [mRS] 0–2) preoperatively (42%). The dAVF location was tentorial in six patients (25%), petrosal in six (25%), superior sagittal sinus in four (17%), torcular in two (7%), floor of the anterior fossa in two (7%), and sphenoid ridge, transverse-sigmoid, inferior sagittal sinus and jugular in one patient each (4%). Four patients had failed endovascular therapy (17%). The angiographic obliteration rate was 96%. The combined permanent morbidity and mortality rate was 17%. After a mean follow-up of 2.1 years, 13 patients improved (54%), seven were the same, (29%) and four were worse (17%). Thirteen patients were asymptomatic (mRS 0, 54%), and 18 were independent (mRS 0–2, 75%). Our results reinforce that surgical treatment of dAVF with direct CVD is associated with a high angiographic cure rate with acceptable morbidity and mortality, particularly in light of the lesions’ natural history.     

硬脑膜动静脉瘘介入栓塞治疗

目的 探讨血管内栓塞治疗硬脑膜动静脉瘘(DAVF)的临床技巧与治疗效果.方法 收集珠江医院自2000年至2009年收治的DAVF患者50例,应用微导管技术,以各种不同材料在数字减影血管造影辅助下行血管内栓塞治疗,通过影像学检查及临床症状随访来评价临床疗效.结果术后即刻造影显示43例瘘口完全闭塞,6例瘘口绝大部份不显影,1例瘘口部分消失.随访6个月至7年,临床症状消失34例,症状明显缓解6例,复发7例,症状加重3例;无一例发生并发症.结论 应用微导管技术栓塞是治疗DAVF的有效手段,正确选择栓塞途径、材料和提高术者技术水平是治疗成功的关键.

Abstract：

Objective To explore the clinical skills and curative efficacy of endovascular embolization on dural arteriovenous fistula (DAVF). Methods A total of 50 patients with DAVF,admitted to our hospital from 2000 to 2009, underwent endovascular embolization with different materials through a microcatheter under DSA. After embolization, imaging examination was applied and clinical manifestations were noted during the clinical follow-up to evaluate the clinical efficacies.Results Immediate postoperative angiography indicated that the fistulas were totally occluded in 43patients, occluded evidently in 6 and occluded partially in 1. The 6-84 months follow-up found that clinical symptoms of 34 patients disappeared, 6 alleviated evidently, 7 relapsed, and 3 worsened; no complications were noted. Conclusion The endovascular embolization for DAVF is effective; and choosing the right embolic approach and material and improving the technology are the keys of successful treatment.     

Severe cerebral venous sinus thrombosis and dural arteriovenous fistula in an infant with protein S deficiency

A 12-month-old infant presented with cerebral seizures and neurological deficits. MRI scan of the brain and angiography showed massive cerebral venous sinus thrombosis complicated by a dural arteriovenous fistula. Subsequent clotting analysis revealed a protein S deficiency. Screening for inherited coagulation inhibitor deficiency is recommended in children with unexplained or atypical thrombotic events. Received: 12 May 1998     

硬脑膜动静脉瘘的临床及影像学特征

目的研究硬脑膜动静脉瘘(duralarteriovenousfistula,DAVF)的临床表现和影像学特征。方法对8例DAVF患者的临床和神经影像学资料进行回顾性分析。结果DAVF临床表现复杂多样,以头痛(4例)和搏动性颅内血管杂音(5例)为主要临床表现,也可以癫痫为首发症状。头部CT和MRI可显示DAVF的一些继发性改变,如蛛网膜下腔出血、颅内出血、广泛的血管流空现象及迂曲扩张异常的血管。MRA、DSA可显示吻合动脉及引流静脉。结论DAVF的CT、MRI、MRA及MRV等具有一定的特征性改变。结合临床资料可提示DAVF,确诊依赖于脑血管造影(DSA)。     

经静脉入路栓塞治疗横窦-乙状窦区的硬脑膜动静脉瘘

目的评价经静脉入路栓塞治疗横窦-乙状窦区硬脑膜动静脉瘘(DAVF)的安全性和有效性。方法经静脉入路到达患侧的横窦-乙状窦,用微弹簧圈填塞病变静脉窦,同时闭塞瘘口。结果经静脉入路治疗横窦-乙状窦区DAVF共16例。病变累及横窦-乙状窦交界处者11例、横窦者3例、乙状窦者2例。根据Cognard分类,IIa型3例,IIb型1例,IIa b型12例。单纯应用静脉入路7例,经静脉入路前先采用经动脉途径栓塞者8例,经静脉入路栓塞治疗后再经动脉途径栓塞者1例。瘘口完全闭塞13例,瘘口残留3例,但瘘口流量已减少95%以上。15例(94%)在栓塞治疗后临床症状消失,1例栓塞后出现颅内出血死亡,未见其他并发症。随访4～23个月,临床症状无复发。11例行造影复查:3例残留瘘口者2例消失,1例曾行3次造影复查瘘无明显变化,由于无临床症状,未再行栓塞治疗;另外8例造影复查未见复发。结论对于适当选择的横窦-乙状窦区DAVF病例,经静脉入路闭塞病变静脉窦是一种安全有效的治疗方法。     

引起脊髓功能障碍的硬膜动静脉瘘的临床特点

目的 回顾性研究引起脊髓功能障碍的硬膜动静脉瘘（DAVF）的临床特点，促进此类疾病的早期诊治。方法 对15例引起脊髓功能障碍的DAVF患者进行诊治。手术相关性DAVF1例，自发性DAVF14例。缓慢起病11例，急性起病4例。磁共振T2加权脊髓周围异常血管流空11例，脊髓被增强7例。血管造影证实硬膜瘘口位于小脑幕1例，颈段4例，胸段7例，腰骶尾段3例。手术靠近瘘口切断引流静脉6例，介入栓塞瘘口6例，介入后手术2例，保守治疗1例。结果 1例手术治疗患者失随访，1例拒绝手术治疗的患者确诊后1周死亡，其余13例患者随访时间为6-58个月。5例手术治疗的患者均治愈；6例介入治疗的患者，3例治愈，2例好转，1例无变化；2例介入后手术治疗的患者，1例好转，1例双下肢顽固性疼痛无变化。结论 掌握引起脊髓功能障碍的DAVF的起病形式、磁共振特点和血管造影检查要点，有利于DAVF的早期诊治、提高治愈率和患者的生命质量。