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Abstract：
BACKGROUND: Jugular foramen dural arteriovenous fistulas (DAVFs) are rare and challenging lesions. Described methods of treatment include embolization and microsurgical disconnection through a far lateral transcondylar approach. The authors present the case of a Borden type III jugular foramen DAVF, which was treated with a novel, less invasive retrosigmoid approach with intradural skeletonization and packing of the sigmoid sinus.
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.
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.
摘要：
背景：颈静脉孔硬脑膜动静脉瘘（DAVFs）是罕见且具有挑战性的病变。所描述的治疗方法包括通过远外侧经髁入路的栓塞和显微外科手术断开。作者介绍了BordenIII型颈静脉孔DAVF的病例，被一本小说对待，侵入性较小的乙状窦后入路，硬膜内骨骼化和乙状窦填塞。
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。
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。
