METHODS: The patient presented with headache and visual field deficit. Neuroimaging demonstrated a right temporal intracerebral hematoma with mass effect. This was due to a Borden type III jugular foramen DAVF with cortical venous reflux into the vein of Labbe secondary to recanalization of a previously thrombosed sigmoid sinus. Microsurgical disconnection was performed via a retrosigmoid approach, in which the sigmoid sinus was identified intradurally at the jugular foramen. The sigmoid sinus was isolated by drilling at the pre- and retrosigmoid spaces to permit packing and clip ligation. Postoperative angiography revealed complete occlusion of the DAVF.
CONCLUSIONS: Jugular foramen DAVFs are rare entities, which have been traditionally treated through a far lateral transcondylar approach. An intradural retrosigmoid approach is a safe, less invasive alternative, which involves less soft tissue and bony dissection and does not have the associated morbidity of craniocervical instability and hypoglossal neuropathy.
方法:患者出现头痛和视野缺损。神经影像学显示右侧颞部脑内血肿具有肿块效应。这是由于BordenIII型颈静脉孔DAVF的皮质静脉回流到Labbe静脉,继发于先前血栓形成的乙状窦再通。显微外科手术是通过乙状窦后入路进行的,其中乙状窦在颈静脉孔处被发现。通过在乙状窦前和乙状窦后空间钻孔来分离乙状窦,以允许包装和夹子结扎。术后血管造影显示DAVF完全闭塞。
结论:颈孔DAVF是罕见的实体,传统上通过远外侧经髁入路治疗。硬膜内乙状窦后入路是安全的,侵入性较小的替代方案,涉及较少的软组织和骨解剖,并且没有相关的颅颈不稳定和舌下神经病变的发病率。