PDF(Pubmed)
Abstract：
Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography revealed a Borden II/Cognard IIa+b DAVF. He underwent stage 1 transarterial embolization of the occipital artery which reduced shunting by 30%. Several attempts were made to access the fistula during stage 2 transvenous embolization, but it was not possible to access the left transverse sinus fistula site since there was no communication across the torcula from the right transverse sinus and the left inferior sigmoid-jugular bulb was occluded. Therefore, a single burr hole was drilled and direct access to the DAVF was achieved with a micropuncture needle under neuronavigational guidance. The left transverse-sigmoid sinus junction was then embolized with coils. After the procedure, angiography revealed that the DAVF was cured with no residual shunting. This case demonstrates how minimally invasive surgery provides an alternative method to access a DVAF when conventional transarterial and/or transvenous embolization treatment options are not possible. Each DAVF case has unique anatomy and physiology, and creative multi-disciplinary strategies can often yield the best results.
摘要：
硬脑膜动静脉瘘（DAVFs）是罕见的颅内血管畸形，具有多种临床体征和症状。其中,颅内出血是一种严重的并发症。一名72岁男性出现头痛和搏动性耳鸣。脑血管造影显示BordenII/CognardIIabDAVF。他接受了1期经枕动脉动脉栓塞术，分流减少了30％。在第2阶段经静脉栓塞期间，进行了几次尝试以进入瘘管，但无法进入左侧横窦瘘部位，因为右侧横窦没有穿过肿瘤的交流，左侧乙状结肠-颈静脉下球闭塞。因此,在神经导航引导下,用显微穿刺针钻了一个钻孔,并直接进入DAVF.然后用线圈栓塞左横乙状窦交界处。手术后,血管造影显示DAVF已治愈，没有残留分流。此案例表明，当传统的经动脉和/或经静脉栓塞治疗方案不可能时，微创手术如何提供进入DVAF的替代方法。每个DAVF病例都有独特的解剖学和生理学，创造性的多学科策略通常可以产生最佳结果。
