脑膜中静脉硬脑膜动静脉瘘9例与文献汇总分析

目的：脑膜中静脉硬脑膜动静脉瘘(Middle Meningeal Vein Dural Arteriovenous Fistula,MMV-DAVF)少见,本文总结其影像学特点、临床表现和血管内治疗。方法：回顾性收集我科自1999年1月至2020年4月之间收治9例MMV-DAVF患者的临床资料、影像学资料和手术及随访资料,并在数据库中检索中英文文献,纳入文献报道中23例患者的上述资料,并作汇总分析。结果：本组9例患者,多数具有外伤史(7/9,77.8%),头痛、颅内杂音是最常见的临床表现,多合并颅骨骨折(4/6,66.7%)及颅内出血(5/6,83.3%)。均经MMV引流至临近静脉窦或静脉丛,所有9例患者均采用血管内Onyx栓塞,7例(77.8%)术后完全栓塞,2例(22.2%)次全栓塞,随访未见复发和新发。综合文献和本组患者共32例患者,有头部外伤史占78.1%,65.6%合并颅骨骨折,62.5%伴有脑部血肿。46.9%表现为头痛,37.8%伴有颅内杂音。62.5%采用动脉入路血管内介入治疗,完全栓塞率80.0%,术后随访未出现DAVF复发和新发。结论：MMV-DAVF少见,但在合并颅骨骨折的情况下,若出现颅内杂音和头痛,应进一步行血管学检查,治疗方式首选血管内介入栓塞治疗。

Middle meningeal vein dural arteriovenous fistula: a report of nine cases and literature review

Objective: The Middle Meningeal Vein Dural Arteriovenous Fistula (MMV-DAVF) is rare, the imaging characteristics, clinical manifestations and endovascular therapy are summarized. Methods: Clinical data, imaging data, surgical and follow-up data of 9 MMV-DAVF patients admitted to our department from January 1999 to April 2020 are collected retrospectively. Chinese and English literatures are searched in the database, and the above data of 23 patients reported in the literature are collected for summary analysis. Results: In this group of 9 patients, most of them have a history of trauma (7/9, 77.8%), headache and intracranial tinnitus were the most common clinical manifestations, most of them were complicated with skull fracture (4/6, 66.7%) and intracranial hemorrhage (5/6, 83.3%). Endovascular embolization with Onyx is performed in all 9 patients, complete embolization is performed in 7 patients (77.8%). No recurrence or new occurrence was found during follow-up. A total of 32 patients are included in the study, 78.1% have a history of head trauma, 65.6% have skull fracture, and 62.5% have brain hematoma. 46.9% presented with headache and 37.8% with intracranial tinnitus. 62.5% of patients are treated with transarterial endovascular embolization, and the complete embolization rate is 80.0%. No DAVF recurrence or new occurrence are found in postoperative follow-up. Conclusion: MMV-DAVF is rare. If there is skull fracture with intracranial tinnitus and headache occur, further angiography should be performed, and endovascular embolization is the preferred treatment.