颅颈交界区硬脊膜动静脉瘘的诊治分析

目的探讨颅颈交界区硬脊膜动静脉瘘的临床及影像学特点、诊断及外科治疗方法。方法回顾性分析11例颅颈交界区硬脊膜动静脉瘘病人的临床资料。行枕下后正中入路C1半椎板切除引流静脉切断术9例，1例合并小脑幕硬脑膜动静脉瘘病人仅行硬脑膜动静脉瘘栓塞术，观察随访1例。结果9例引流静脉切断病人中，6例以蛛网膜下腔出血起病者术后无明显神经功能障碍；1例术前双下肢肌力0级．大便困难、小便失禁者术后双下肢肌力逐渐恢复至Ⅳ级，大小便能控制；2例以肢体麻木就诊者术后症状消失。术后脊髓动脉造影显示原瘘口及粗大的引流静脉、动脉瘤样改变等均消失；随访1个月～5年，均未见复发。结论颅颈交界区硬脊膜动静脉瘘多表现为蛛网膜下腔出血。血管造影检查应尽量全面，避免漏诊。枕下后正中入路硬脊膜动静脉瘘引流静脉切断术适用于治疗本病。

Diagnosis and treatment of dural arteriovenous fistula at the craniocervical junction

Objective To explore the clinical manifestations, imaging features, diagnosis and surgical treatment of dural arteriovenous fistula at the craniocervical junction. Methods Clinical data from I I patients with dural arteriovenous fistula at the craniocervical junction were analyzed retrospectively. Nine patients received Cl semi-vertebral plate resection and interruption of the draining vein through posterior median suboccipital approach; one patient with complex tentorial dural arteriovenous fistula underwent simple embolization therapy; one patient was given a follow-up observation. Results Among 9 patients undergoing interruption of the draining vein, 6 presenting with subarachnoid hemorrhage （SAH） had no significant postoperative neurological deficit. The muscle strength of one patient with paraplegia was significantly improved from grade 0 to grade IV, and the urination and defecation could be self-controlled after surgical operation. The symptom completely disappeared post-operation in the 2 patients complaining of limb numbness. Postoperative DSA showed the fistula, dilated draining veins and aneurismal structures disappeared. During a follow up period of 1 month to 5 years, no recurrence was found. Conclusion Most dural arteriovenous fistulas at the craniocervical junction present as SAH. Comprehensive DSA should be performed to avoid misdiagnosis. Interruption of draining vein for dural arteriovenous fistula through posterior median suboccipital approach is an optimal modality of surgical treatment.