摘要
目的分析海绵窦区硬脑膜动静脉瘘(cavernous sinus dural arteriovenous fistula,CSDAVF)患者的临床特征,探讨机制。方法分析17例海绵窦区硬脑膜动静脉瘘患者的临床表现、脑脊液和神经影像特点,对CSDAVF进行介入栓塞治疗和术后随访。结果男女比例1:2.4,平均发病年龄(58.12±14.61)岁,中老年患者合并高血压者比例较同年龄段普通人群明显升高。首发症状以头痛为表现者6例,眼部症状5例,颅内杂音2例,复视2例,头晕和言语含糊各1例。17例患者均进行全脑血管造影,14例患者进一步行介入栓塞治疗,多数患者术后预后良好。以头痛为首发症状的患者中,2例患者表现为直立性头痛,其中1例证实伴有低颅压,并在头痛3个月后逐渐出现突眼症状。2例以直立性头痛起病的患者均在确诊CSDAVF后行介入栓塞治疗,手术后患者头痛、突眼症状消失,分别随访3年及2年无临床症状。结论本研究中,CSDAVF好发于中老年女性,更倾向于高血压患者,临床表现多样,少数患者可以直立性头痛作为首发症状,应给予重视,针对疑诊的CSDAVF,建议进一步行CTA或DSA以明确诊断。介入栓塞是确诊的CSDAVF患者首选的治疗方法。
Objective To investigate the clinical characteristics and mechanism of cavernous sinus dural arteriovenous fistula （CSDAVF）. Methods The clinical data of 17 CSDAVF patients, including clinical manifestations, characteristics of cerebrospinal fluid （CSF） and neuroimaging, were analyzed. The interventional catheter embolization of CSDAVF and postoperative follow-up were performed. Results Of the 17 subjects with CSDAVF, 5 （29.4%） were men and 12 （70.6%） were women （sex ratio=1：2.4）. The average age of onset was （58.12±14.61） years old. Older CSDAVF patients were prone to be complicated with hypertension than general population at the same age. Onset symptoms included headache in 6 cases, eye symptoms in 5 cases, intracranial murmur in 2 cases, diplopia in 2 cases, dizziness in 1 case and slurred speech in 1 case. Digital subtraction angiography （DSA） was performed in all 17 patients. Further embolization was applied in 14 patients and had satisfactory outcome. In CSDAVF patients with headache, 2 patients showed orthostatic headache as initial symptom. One of them with intracranial hypotension reported exophthalmos 3 months after the onset. Those two patients remained asymptomatic during 3-year and 2-year follow-up after receiving interventional catheter embolization for CSDAVF. Conclusions CSDAVF usually occurs in middle-aged and older women, especially in those with hypertension. CSDAVF varies in clinical manifestations. A special attention should be given to orthostatic headache which can be presented as the initial symptom in few patients with CSDAVF. CTA or DSA should be considered in patients with clinically suspected CSDAVF to rule out the possibility of CSDAVF. The interventional catheter embolization is the primary treatment of CSDAVF.
作者
魏慧星
杨锦珊
庄金红
陈萍萍
陈龙飞
吴钢
WEI Huixing, YANG Jinshan, ZHUANG Jinhong, CHEN Pingping, CHEN Longfei, WU Gang.(Department of Neurology, the First Affiliated Hospitcd of Fujian Medical University, Fuzhou 350005, China)
出处
《中国神经精神疾病杂志》
CAS
CSCD
北大核心
2017年第12期732-736,共5页
Chinese Journal of Nervous and Mental Diseases
基金
国家临床重点专科项目(编号:2012-GJLCZD)
福建省临床重点专科项目(编号:2012-SLCZD)
福建省自然科学基金(编号:2017J05123)
福建医科大学启航基金(编号:2016QH067)
关键词
海绵窦硬脑膜动静脉瘘
临床表现
直立性头痛
低颅压
介入栓塞
Cavernous sinus dural arteriovenous fistula Clinical characteristic Orthostatic headache Intracranial hypotension Interventional catheter embolization
