摘要
目的 分析海绵窦段颈内动脉-侧裂-Labbé静脉瘘伴巨大静脉瘤的临床特征和外科治疗策略.方法 显微外科手术闭合脑膜动静脉瘘口,切除静脉瘤,同时保留Labbé静脉的正常回流.复习相关文献中具有皮层逆向静脉同流并伴有静脉扩张或静脉瘤形成的Cognard Ⅳ型颅内硬膜动静脉瘘（DAVF）病例.结果 该患者术后未遗留神经功能障碍,术后DSA显示瘘口完全闭合,侧裂静脉瘤和DAVF消失.随访5年,未见DAVF复发.文献病例中,66%的患者表现为颅内出血;选择性阻断引流静脉,即可完全永久地闭合瘘口;13例具有明确静脉瘤形成者,9例给予手术切除或电凝静脉瘤.结论 这种逆向皮层静脉回流的DAVF病例,尤其是静脉曲张或扩大的病例,往往具有侵袭性病程.选择性手术阻断引流静脉,同时切除静脉瘤,是对该类型DAVF的有效治疗方法.
Objective To observe the clinical characteristics of the cavernous sinus artery - sylvian -venous remained with surgical resection of venous aneurysm. The literatures of patients with the Cognard Ⅳ DAVF were reviewed. Results There were no neurological deficits in this patient after microsurgical treatment. The digital subtractions angiogram showed that the fistula was completely occluded and venous aneurysm disappeared. The recurrence of DAVF was not found during the five - year follow - up. Among the review of literatures, there were 66% patients with intracranial hemorrhage;the fistulas were occluded completely and permanently through the selective disconnection of venous drainage;in 13 patients with venous aneurysm, 9 patients of them were treated though the surgical resection or coagulation of venous aneurysms. Conclusions Patients with DAVF associated with retrograde cortical venous drainages,especially with venous ectasia or aneurysms, have more often aggressive course. Selective disconnection of venous drainage and resection of venous aneurysm may provide an effective treatment option of this subtype of DAVF.
出处
《中华神经外科杂志》
CSCD
北大核心
2010年第9期804-807,共4页
Chinese Journal of Neurosurgery
