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。     

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]     

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。     

手术治疗硬脑膜动静脉瘘

目的探讨手术切除硬脑膜动静脉瘘的方法。方法2005年5月至2006年6月共收治7例难治性硬脑膜动静脉瘘患者，男性6例，女性2例，年龄25-42岁。病变部位以双侧大脑凸面硬脑膜为主3例，乙状窦小脑幕病灶2例，前颅窝和眶尖病灶1例，矢状窦双侧乙状窦1例。手术依据病灶部位，选择额颞、颞枕、额下、乙状窦前或联合入路，电凝、离断病灶供血动脉，切除受累的病变硬脑膜，沿动脉化静脉分流方向寻找瘘口，切断动静脉分流，必要时也可切断压力较高严重动脉化的静脉窦，改善静脉回流，恢复神经功能缺失。结果8例中5例病人术后症状消失或明显好转。硬脑膜动静脉瘘消失，1例手术中出血死亡。结果手术切除各种复杂硬脑膜动静脉瘘可作为一种有效的方法，但应防止术中较大的动静脉瘘和静脉窦撕裂产生的致使性出血。     

烟雾病合并颅内硬脑膜动静脉瘘1例报告并文献复习

目的 探讨烟雾病(MMD)合并颅内硬脑膜动静脉瘘(DAVF)的病因及治疗方式。方法 回顾性分析1例MMD合并颅内DAVF患者的临床资料,并对相关文献进行复习。结果 本例患者为青年女性,以脑室出血为首发症状,DSA诊断为MMD合并左横窦乙状窦DAVF,行右侧颅内外血管吻合术后6个月复查示桥血管通畅,瘘口消失。结合文献复习,MMD合并DAVF分为同时伴发或继发两类,临床表现多为与MMD相关的脑缺血或脑出血。治疗常采用颅内外血管吻合术,而DAVF大多数保守治疗。结论 MMD合并DAVF少见,病因不明,可能与促血管生长因子增加有关。治疗策略取决于患者临床表现和DAVF分型。     

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3例报告及文献复习

正1病例介绍1.1病例1患者女性,53岁,因反复头痛伴头昏、胡言乱语1月余于2018年1月10日入院。患者1个月前开始无明显诱因出现头痛,以左侧额部、头顶部为主,呈阵发性针刺样,每次发作时间数小时不等,程度可耐受,且伴有头昏沉,并多次出现发作性胡言乱语、答非所问、行走缓慢,无恶心呕吐、视物模糊、肢体抽搐等。既往近30年来有反复发作头痛病史,平时涂抹风油精或清凉油可稍缓解,未诊治。有青     

硬脑膜动静脉瘘一例

目的增进对硬脑膜动静脉瘘(DAVF)临床表现、发病机制的认识。方法并分析一例DAVF患者的临床资料。结果本例患者的临床表现主要为左眼视物模糊及阵发性黑矇,MRA及DSA提示右侧窦区(横窦-乙状窦交界处)DAVF,右侧横窦-乙状窦交界处闭塞,DSA显示左侧横窦-乙状窦交界处局限性狭窄。结论 DAVF的临床表现多样且不特异,对于不明原因出现视力障碍、尤其是单眼视力障碍伴视乳头水肿、眼底出血等情况,甚至伴有搏动性耳鸣等症状,应高度注意是否存在DAVF。     

后颅窝硬脑膜动静脉瘘（附17例报告）

报告１７例后颅窝硬脑膜动静脉瘘，并对其病因、血供、临床特征、血流动力学改变及血管内栓塞进行讨论。本组资料提示，头痛和颅内杂音是最常见的发病症状；侧窦闭塞与病变的发展有密切关系；选择性血管内栓塞是有效的治疗方法。     

经单侧椎板开窗夹闭硬脊膜动静脉瘘

目的　总结经单侧椎板开窗入路夹闭硬脊膜动静脉瘘的经验。方法　回顾性分析了 5 6例经脊髓MR和脊髓血管造影确诊的硬脊膜动静脉瘘患者经单侧椎板开窗夹闭瘘口的临床资料。结果　 5 4例患者术后行脊髓血管造影复查 ,显示瘘口全部消失。 38例患者术后 6个月行脊髓MR复查 ,显示脊髓周围的血管流空影完全消失 ,T2 像髓内高信号影消失或明显减少。 5 4例患者获随访 ,随访时间 3～ 36个月 ,2 4例症状完全消失 ,2 7例症状改善 ,3例无变化。结论　经单侧椎板开窗夹闭瘘口的手术方法是硬脊膜动静脉瘘的首选治疗方法。     

Transarterial Embolization of Intracranial Arteriovenous Fistulas with Large Venous Pouches in the Form of Venous Outlet Ectasia and Large Venous Varix or Aneurysm : Two Centers Experience

ObjectiveThere are different types of cerebral vascular malformations. Pial arteriovenous fistulas (PAVFs) and dural arteriovenous fistulas (DAVFs) are two entities; they consist of one or more arterial connections to a single venous outlet without a true intervening nidus. The high turbulent flow of PAVFs and aggressive DAVFs with cortical venous reflux can result in venous outflow varix and aneurysmal dilatation. They pose a significant challenge to transvenous embolization (TVE), stereotactic radiosurgery, and surgical treatment. We aim to share our centers’ experience with the transarterial embolization (TAE) for arteriovenous fistulas (AVFs) with large venous pouches and to report the outcome. MethodsThe authors’ two institutions’ databases were retrospectively reviewed from February 2017 to February 2021. All patients with intracranial high flow PAVFs and aggressive DAVFs with venous outlet ectasia and large venous varix and were treated by TAE were included. ResultsFifteen patients harboring 11 DAVFs and four PAVFs met our inclusion criteria. All patients underwent TAE in 17 sessions. Complete angiographic obliteration was achieved after 14 sessions in 12 patients (80%). Four patients (25%) had residual after one TAE session. Technical failure was documented in one patient (6.7%). Fourteen patients (93.3%) had favorable functional outcome (modified Rankin score 0–2). ConclusionsTAE for high flow or aggressive intracranial AVFs is a safe and considerable treatment option, especially for those associated with large venous pouches that are challenging and relatively high-risk for TVE.     

硬脑膜动-静脉瘘合并髓静脉扩张的临床及影像学表现(附1例报告及文献复习)

目的报道1例硬脑膜动-静脉瘘(DAVF)合并髓静脉扩张病例的临床资料,探讨DAVF合并髓静脉扩张的临床及影像学表现。方法回顾性收集1例DAVF合并髓静脉扩张患者的临床及影像学资料,并结合文献复习进行分析。结果患者以症状性癫痫起病。头颅MRI表现为脑白质内迂曲、扩张血管影,并继发性脑梗死和脑水肿;全脑数字减影血管造影(DSA)提示右侧颈内动脉造影静脉期上矢状窦前1/3不显影,静脉晚期颅内多发髓静脉迂曲增粗,经室管膜下静脉-大脑内静脉回流,右侧颈外动脉造影示DAVF形成,大脑上静脉逆向回流,左侧颈内动脉造影示左侧发育性静脉畸形。经血管内介入栓塞DAVF治疗后患者病情改善。结论DAVF合并髓静脉扩张少见,可继发脑实质病变进而出现神经功能缺损症状与体征;影像学表现为头颅MRI提示髓静脉扩张涉及的疾病谱较多,需仔细鉴别;MRI和DSA联合检查能更好评价脑实质和血管情况。     

自发性低颅压致脑静脉窦血栓形成合并多发梗死1例报道及文献复习

目的探讨自发性低颅压致脑静脉窦血栓形成患者的临床、影像学特点和发病机制。方法报道1例自发性低颅压致脑静脉窦血栓形成并脑内多发静脉性梗死患者的临床资料。结合临床、影像学特点及相关文献报道对其进行分析。结果自发性低颅压可导致脑静脉窦血栓形成。静脉系统扩张及血液瘀滞是血栓形成的主要机制。严重的血液瘀滞患者可出现多发皮质静脉性梗死,甚至脑干静脉性梗死,经治疗后多数患者症状消失。结论自发性低颅压是脑静脉窦血栓形成的重要危险因素。静脉性梗死可以出现在脑干。早期发现并治疗,多数患者预后良好。     

Diffusion-Weighted Magnetic Resonance Imaging of Spontaneous Venous Infarction and Cortical Hemorrhage Complicating Dural Arteriovenous Fistula

Dural arteriovenous fistula (DAVF) is an abnormal arteriovenous shunt that occurs in the dura matter within or near a dural sinus. The clinical manifestations vary. The authors report herein a rare case of type III DAVF presenting with coexisting intracranial hemorrhage (ICH) and venous infarction evidenced by computed tomography (CT) and diffusion-weighted magnetic resonance imaging. Conventional angiography proved that the right middle meningeal artery and the occipital artery supplied the DAVF, with direct drainage into the cortical veins and superior sagittal sinus.     

Atlas Shrugged: Cervical Myelopathy Caused by Congenital Atlantoaxial Dislocation Aggravated by Child Labor

BackgroundSymptomatic atlantoaxial dislocation is common in predisposing genetic or acquired disorders. However, an isolated atlantoaxial dislocation frequently is congenital and silent unless discovered during course of evaluation for neurological symptoms of cervical spinal cord injury attributed to minor or chronic, repetitive trauma.PatientA 12-year-old girl working as a farm laborer developed calf pain provoked by walking, which increased in severity and progressed to involve the upper limbs. It was followed by progressive ascending quadriplegia. The illness resembled acute inflammatory demyelinating polyneuropathy with respiratory involvement. Presence of “claw” hands bilaterally and wasting of intrinsic muscles of the hands led to the suspicion of a cervical myelopathy.ResultNeuroimaging confirmed a congenital atlantoaxial dislocation with basilar invagination. The absence of abnormal signals in the cervical spinal cord was unusual. The symptomatic congenital atlantoaxial dislocation was postulated to be precipitated by chronic trauma suffered while habitually carrying heavy loads on the head and leading to spinal cord injury without radiographic abnormalities. Correction via surgery was successful.ConclusionsCongenital atlantoaxial dislocation should be suspected in a clinical setting of neurological symptoms of cervical spinal cord injury without obvious trauma or predisposing primary diseases. Prompt cervical spine imaging reveals the correct diagnosis. Physicians in countries in which child labor is rampant should be aware of the potential complications of cervical cord injuries from child labor.