儿童硬脑膜动静脉瘘1例

1 临床资料 患儿男,9岁,1个多月前无明显诱因于户外玩耍时出现晕厥发作,表现为意识丧失,双眼凝视,稍右斜,四肢软,无牙关紧闭,无口唇发绀,持续约10分钟后患儿出现恶心,吐"白水",后意识清醒,醒后患儿反应如常.既往史:患儿平素走路易足尖着地,喜安静坐卧,不喜跑跳.无遗传病史.入院查体:体温36.4℃,脉搏98次/m ...     

硬脑膜动静脉瘘诊治新进展

硬脑膜动静脉瘘 (ｄｕｒａｌａｒｔｅｒｉｏｖｅｎｏｕｓｆｉｓｔｕｌａ ,ＤＡＶＦ)是常见颅内血管性疾病 ,在国外占颅内血管畸形的 10 %～ 15 % [1] ,在我国占脑血管病患者的 6.2 % ,以横窦 -乙状窦区发生率最高 ,其次为海绵窦区、上矢状窦区等[2 ] 。该病成人多见 ,尤其是 40～60岁年龄组多发 ,目前多数学者认为它是后天性疾病[3 ] 。1　发病机制与病因其病因包括 :①静脉窦炎或栓塞[3 ] 。正常情况下 ,部分脑膜动静脉终止于窦壁附近 ,发出许多细小分支营养窦壁硬膜 ;另外 ,Ｈａｍａｄａ等[4] 发现该病的病变基础是在硬膜动脉与扩张的小静…     

硬脑膜动静脉瘘的治疗

目的：探讨硬脑膜动静脉瘘的病因，分类及治疗。方法：26例均采用超选择插管栓塞，其4例同时行静脉入路静脉窦内栓塞，联合手术2例，X-刀治疗l例。结果：海绵窦区硬膜动静脉瘘者，17例瘘口完全消失，4例栓塞后瘘口有残留，结合颈动脉压迫法后2例瘘口消失。侧窦硬脑膜动静脉瘘者，瘘口完全消失3例，部分消失2例。结论：血管内栓塞治疗硬脑膜动静脉瘘是目前最安全、有效的治疗方法。联合手术或放射治疗等，可大大提高硬脑膜动静脉瘘的临床治疗愈率。     

海绵窦区硬脑膜动静脉瘘影像学表现与栓塞治疗

海绵窦区硬脑膜动静脉畸形瘘（dural arterioveous fistula，DAVF）是指海绵窦区及其附近硬脑膜动静脉之间的异常交通，属脑血管畸形的一种，其临床表现、影像学表现及治疗均有其特点。本文报告13例DAVF病例的临床与影像学资料，并结合文献作一回顾性分析。     

硬脑膜动静脉瘘

报告４例硬脑膜动静脉瘘。对其病因、临床特征、诊断及血管内栓塞治疗进行了讨论。多枝细小动脉供血者，以液态栓塞物栓塞治疗效果较好，较大瘘口以固态栓塞物效果较好。栓塞治疗中应注意＂危险吻合＂的存在，防止误栓。     

硬脑膜动静脉瘘的治疗探讨

硬脑膜动静脉瘘 (Ｄｕｒａｌａｒｔｅｒｉｏｖｅｎｏｕｓｆｉｓｔｕｌａｅ ,ＤＡＶＦ)是一类主要累及脑膜及其附属物的血管性疾病 ,其病理特点是颅内外供血动脉直接与颅内静脉窦沟通 ,病灶内血流快 ,正常脑区因低灌流而缺血缺氧 (盗血 ) ,从而引起颅脑一系列病理生理变化。本文报告 8例硬脑膜动静脉瘘的血管内治疗及评价1　临床资料　　一般资料 :男 7,女 1;年龄 2 1～ 5 1岁 ,平均 2 8 3岁。病因 :头部外伤 1例 ;无明显诱因 7例。临床表现 :颅内杂音 8例 ;头皮搏动性包块 3例 ;眼睑静脉怒张伴眼球突出 2例 ;蛛网膜下腔出血 2例 ,牙龈出血 1…     

硬脑膜动静脉瘘临床表现与治疗策略

硬脑膜动静脉瘘(DAVF)是硬脑膜的动静脉异常沟通,良性的DVAF一般没有特殊症状而被忽略,恶性的DVAF常因出现搏动性头痛和颅内出血而被发现。DAVF患者辅助检查方法有DSA、SWI、MRA、CTA等,但惟一确诊手段还是靠DSA,且DVAF患者的治疗策略也主要是根据DSA检查结果来决定的。可以通过手术、介入和立体定向放射来治疗DAVF,目前血管内栓塞技术是主要的治疗方法。本文就DAVF的流行病学、自然史、病变分类、临床表现、影像学特征和治疗方案等方面作一综述。     

显微外科手术治疗硬脑膜动静脉瘘

目的:探讨单纯显微外科手术治疗硬脑膜动静脉瘘的疗效.方法:回顾性分析自2000年11月～2006年1月新疆医科大学第一附属医院收治9例及第五附属医院收治1例均行开颅手术治疗的硬脑膜动静脉瘘患者.对所有患者行开颅手术,在显微镜下将所见供血动脉电凝切断,于近瘘口处进入蛛网膜下腔前将引流静脉阻断夹闭.术后12～27天4例患者复查全脑血管造影,并对所有患者进行2～50个月(平均22.6个月)的上门随访.结果:4例患者复查全脑血管造影:瘘口均消失.7例症状消失,1例好转,1例未改善,1例死亡.结论:显微外科手术治疗可以有效治疗硬脑膜动静脉瘘.     

不典型硬脊膜动静脉瘘6例临床分析

硬脊膜动静脉瘘(SDAVF)是脊髓血管畸形疾病中最常见的一种,主要表现为横贯性脊髓损害,影像学多表现为长节段脊髓病变伴脊髓表面增多迂曲血管影.该病临床上相对少见,并且可有不典型表现,极易漏诊或误诊为脊髓炎性反应性疾病或椎间盘退行性变等,早期诊断和治疗能明显改善预后.文章对6例不典型SDAVF患者临床特征和实验室资料进行...     

肺动静脉瘘的诊断与治疗(附16例报告)

目的 分析归纳肺动静脉瘘的临床特征及诊断治疗经验,提高临床诊断及治疗水平.方法 回顾2000-2010年北京协和医院胸外科治疗的16例肺动静脉瘘患者,结合文献资料总结肺动静脉瘘的临床诊断及治疗规律.结果 本组16例患者均成功手术切除病灶.其中13例单发PAVF患者行肺叶切除术,症状显著改善甚至消失;双肺弥漫性PAVF患...     

海绵窦区硬脑膜动静脉瘘的栓塞治疗

目的：探讨海绵窦区硬脑膜动静脉瘘的病因及诊治方法。方法：21例均采用超选择插管栓塞，其中4例同时静脉入路微弹簧圈海绵窦内栓塞。结果：17例瘘口完全消失；4例栓塞后瘘口有残留，结合颈动脉压迫法治疗后2例瘘口消失。结论：血管内栓塞治疗海绵窦区硬脑膜动脉瘘是目前行之有效的方法。     

自动触发椭圆形中心编码对比增强磁共振血管成像技术在脊髓硬膜动静脉瘘中的初步应用

目的初步探讨自动触发椭圆形中心编码对比增强磁共振血管成像(MRA)技术在脊髓硬膜动静脉瘘(SDAVF)中的应用价值。方法对5例疑为胸腰段的SDAVF患者行椭圆形中心编码的增强MRA检查,均经选择性脊椎动脉造影和手术证实。结果自动触发椭圆形中心编码的增强MRA显示,5例SDAVF患者的瘘口水平和引流静脉的方向均与数字减影血管造影检查和手术结果相符。MRA检查对于瘘口的定位和引流静脉引流方向的诊断准确率达100%。结论在脊髓血管造影前,椭圆形中心编码的增强MRA检查可以帮助诊断SDAVF,并能初步明确其瘘口水平。     

脊髓硬脊膜动静脉瘘的临床和影像学特点(附1例典型病例分析)

目的 探讨脊髓硬脊膜动静脉瘘(SDAVF)的临床和影像学特点,提高对该病的诊疗能力.方法 报道1例经磁共振和血管造影及手术证实的SDAVF病例,并复习相关文献.结果 SDAVF表现为不同程度的脊髓损害症状,临床缺乏鲜明的特点,易误诊,磁共振平扫及增强检查通常可以发现长节段脊髓病变及脊髓表面迂曲的扩张静脉,数字减影血管成...     

Update of embolization of intracranial dural arteriovenous fistula

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous communications within the dura locating near a major venous sinus and are supplied by pachymeningeal arteries. DAVFs represent 10–15% of all intracranial arteriovenous malformations. The natural history and clinical manifestations are determined by location of the DAVFs and their angioarchitecture. Aggressive DAVF is usually associated with leptomeningeal venous drains or reflux. It may present with hemorrhagic or nonhemorrhagic stroke. The goal of embolization of DAVFs is total fistula occlusion without interfering with the normal dura–venous drains. Embolization can be performed by transarterial and/or transvenous routes or direct puncture of affected dural sinus. Selection of embolic materials depends on access route and angioarchitecture of the fistula. With the involution of endovascular devices, embolic materials, and high-quality angiography, endovascular embolization of DAVFs has been proved a safe and effective method of treating these complex cerebrovascular lesions.     

Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases

Background  Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.
Methods  From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.
Results  All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.
Conclusions  Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.

     

脊髓硬脊膜动静脉瘘6例临床分析

目的:探讨脊髓硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)的临床特征、影像学特点及治疗,以期提高对SDAVF的早期识别和诊断.方法:对上海市普陀区人民医院神经外科收治住院的6例SDAVF患者临床表现、影像学资料及治疗进行回顾性分析.结果:6例患者中5例为男性,1例为...     

海绵窦区硬脑膜动静脉瘘的治疗探讨

目的 探讨海绵窦区硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)的治疗方法、效果及预后.方法 25例患者中8例行颈动脉压迫或仅随访观察;17例行血管内栓塞,其中3例经静脉途径栓塞,13例经动脉途径栓塞,其中1例联合使用覆膜支架和Glubran胶治疗,1例经动脉途径治疗后再次接受经静脉途径栓塞治疗.结果 8例行颈动脉压迫或随访观察的患者中有4例症状缓解或消失,其余患者无加重;3例经静脉途径栓塞者均通过同侧或对侧岩下窦入路完全闭塞瘘口;13例经动脉途径栓塞者中4例完全闭塞瘘口,其余患者症状部分缓解;1例患者首次经动脉途径部分栓塞术后症状加重,急诊经眼上静脉穿刺置管完全栓塞.结论 海绵窦区DAVF总体预后良好,可根据患者症状和影像学特征选择恰当的治疗方式,经静脉途径栓塞治愈率高,适宜者应作为首选治疗方法.     

兔硬脑膜动静脉瘘模型的血管造影

目的 研究硬脑膜动静脉瘘(Dural arteriovenous fistula, DAVF)模型,探讨其血管影像变化。方法 将60只中国本兔分为假手术组(A组)、 单纯结扎组（B 组）、颈外静脉-颈总动脉吻合组（C组）和颈内静脉-颈总动脉吻合组（D组）,制作DAVF模型,并对其行血管造影。结果 C组、D组分别有4只和1只动物出现阳性体征,其静脉压力与直径均显著增加;血管造影证实存在DAVF,循环时间延长,尤其是静脉期明显延长。结论 通过手术将颈动静脉直接吻合,可以引起显著的静脉系高压,并诱发DAVF,其影像特点为循环时间延长,尤其是静脉期明显延长,提示静脉窦及整个头面部静脉系统压力明显增高,血液回流受阻。