表现为蛛网膜下腔出血的高颈段硬脊膜动静脉瘘

目的对表现为蛛网膜下腔出血的高颈段硬脊膜动静脉瘘发病机制进行分析,预测出血因素,避免漏诊,指导治疗。方法对5例表现为蛛网膜下腔出血的高颈段硬脊膜动静脉瘘的临床资料进行总结。结果5例瘘口均位于枕大孔区～颈2节段,由椎动脉脊膜支供血．通过髓周静脉引流。所有5例引流静脉均向颅内引流,有不同程度扩张,3例伴有静脉瘤样改变。手术后复合瘘口均消火,4例治愈,1例死亡。结论高颈段硬脊膜动静脉瘘向颅内引流并伴有引流静脉扩张易出血,颅内压增高可能是诱发出血的因素。血管造影应全面,避免小部分蛛网膜下腔出血的患者造影假阴性。手术夹闭瘘口并切断近端引流静脉是可靠的治疗方法。

Superior cervical dural arteriovenous fistulas presented with subarachnoid hemorrhage

Objective To predict the risk of hemorrhage and investigate diagnosis and treatment of superior cervical spinal dural arteriovenous fistula (SDAVF) presented with subarachnoid hemorrhage (SAH).Methods Five patients with superior cervical spinal arteriovenous fistulas presented with SAH were reported.Clinical data including computed tomography (CT),angiography and outcome of treatment were retrospectively analyzed.Results All orificium fistulae,found at cervicomedullary junction to C2 segment,were drained by peri-marrow veins,the blood supplied by dural branch of vertebral artery.All cases had ascending intracranial drainage via dilated perimedullary veins and 3 cases of them had varix in draining systems.Postoperative angiography showed no fistulas in any cases.Of all,four cases were cured, and 1 died of pulmonary infection.Conclusion Superior cervical SDAVF that manifests an ascending and dilated intracranial venous drainage presents an increased risk of SAH.Meanwhile increased intracranial pressure may induce SAH.Thorough angiography is necessary for the detection of cervical SDAVF.Surgical interruption of fistula and coagulation of proximal draining vein is the credible treatment for this disease.