前颅窝底硬脑膜动静脉瘘的外科治疗

目的 分析12例前颅窝底硬脑膜动静脉瘘(dural arteriovenous fistulas, DAVFs)外科治疗方法和结果,探讨治疗的必要性及如何提高疗效.方法 行六血管全脑血管造影,结合CT、MRI,分析影像学特点,全麻下进行经颅手术夹闭瘘口或血管内栓塞治疗.3例经眼动脉分支供血动脉到接近瘘口处用10%～20%的NBCA胶栓塞,1例经颌内动脉分支接近瘘口用ONYX胶栓塞,2例经颌内动脉以PVA栓塞;6例(包括1例经静脉入路血管内治疗失败后)经前颅窝底入路用动脉瘤夹直接夹闭位于筛板的瘘口的静脉端.结果 6例前颅窝底DAVFs直接手术夹闭瘘口治愈;4例经动脉入路栓塞治愈;2例经动脉入路栓塞治疗后好转.结论 前颅窝底DAVFs直接手术效果好;经动脉入路栓塞到瘘口静脉端也可治愈,但需防止并发症.

Surgical management of dural arteriovenous fistulas in anterior cranial fossa

Objective To analyze the surgical methods and results of 12 patients with dural arteriovenous fistulas in anterior cranial fossa to investigate the necessity and efficacy. Methods The radiographic characteristics were analyzed by six vessels angiography combined with CT and Mill. The patients were treated with surgical clipping or endovascular therapy under general anesthesia. Among six patients with transarterial embolization, three patients were embolized with 10%～20% NBCA through feeding vessels from ophthalmic artery, one with ONYX from internal maxillary artery, and two with PVA particle. The vascular connection was surgical clipped by trans-low-frontal approach in other six patients, including one with failure of transvenous embolization. Results All six patients with surgical clipping were totally cured. The DAVF treated by transarterial embolization was obliterated in 4 patients and relieved in 2 patients. Conclusions Direct surgical clipping can get good result for DAVF of anterior cranial fossa. Transarterial embolization in venous segment of dural connection can also occlude the DAVF with caution in prevention of complication.