PDF(Pubmed)
Abstract：
UNASSIGNED: Arteriovenous fistulas (AVFs) of the craniocervical junction (CCJ) and intradural AVFs are often associated with aneurysms and varics, and it is sometimes difficult to identify the ruptured point on radiological images. We report a case in which vessel wall magnetic resonance image (VW-MRI) was useful for identifying the ruptured point at the CCJ AVF.
UNASSIGNED: A 70-year-old man presented with a sudden onset of headache. He had Glasgow Coma Scale E4V5M6, world federation of neurosurgical societies (WFNS) Grade I. Fisher group 3 subarachnoid hemorrhage and hydrocephalus were found on head computed tomography. Cerebral angiography showed a spinal AVF at the C1 level of the cervical spine. Magnetic resonance image-enhanced motion sensitized driven equilibrium (MSDE-method showed an enhancing effect in part of the AVF draining vein, but the vascular architecture of this lesion was indeterminate. We performed continuous ventricular drainage for acute hydrocephalus and antihypertensive treatment. Cerebral angiography was performed 30days after the onset of the disease, and was revealed an aneurysmal structure in a portion of the AVF draining vein, which VW-MRI initially enhanced. On the 38th day after onset, he underwent direct surgery to occlude the AV fistula and dissect the aneurysmal structure. Histopathology showed that the aneurysmal structure was varices with lymphocytic infiltration, and hemosiderin deposition was observed near the varices.
UNASSIGNED: Recently, VW-MRI has been reported to show an association between the enhancement of varices in dural AVF and rupture cases. VW-MRI, especially the enhanced MSDE method, may be useful in estimating the ruptured point in arteriovenous shunt disease.
UNASSIGNED: A 70-year-old man presented with a sudden onset of headache. He had Glasgow Coma Scale E4V5M6, world federation of neurosurgical societies (WFNS) Grade I. Fisher group 3 subarachnoid hemorrhage and hydrocephalus were found on head computed tomography. Cerebral angiography showed a spinal AVF at the C1 level of the cervical spine. Magnetic resonance image-enhanced motion sensitized driven equilibrium (MSDE-method showed an enhancing effect in part of the AVF draining vein, but the vascular architecture of this lesion was indeterminate. We performed continuous ventricular drainage for acute hydrocephalus and antihypertensive treatment. Cerebral angiography was performed 30days after the onset of the disease, and was revealed an aneurysmal structure in a portion of the AVF draining vein, which VW-MRI initially enhanced. On the 38th day after onset, he underwent direct surgery to occlude the AV fistula and dissect the aneurysmal structure. Histopathology showed that the aneurysmal structure was varices with lymphocytic infiltration, and hemosiderin deposition was observed near the varices.
UNASSIGNED: Recently, VW-MRI has been reported to show an association between the enhancement of varices in dural AVF and rupture cases. VW-MRI, especially the enhanced MSDE method, may be useful in estimating the ruptured point in arteriovenous shunt disease.
摘要：
■颅颈交界区（CCJ）的动静脉瘘（AVF）和硬膜内AVF通常与动脉瘤和静脉曲张有关，有时很难在放射学图像上识别破裂点。我们报告了一种情况，其中血管壁磁共振图像（VW-MRI）可用于识别CCJAVF的破裂点。
■一名70岁的男子突然出现头痛。他患有格拉斯哥昏迷量表E4V5M6，世界神经外科学会联合会（WFNS）I级。在头部计算机断层扫描中发现了Fisher组3蛛网膜下腔出血和脑积水。脑血管造影显示颈椎C1水平的脊髓AVF。磁共振图像增强的运动敏化驱动平衡（MSDE方法在部分AVF引流静脉中显示出增强作用，但是这个病变的血管结构是不确定的。我们对急性脑积水和降压治疗进行了持续脑室引流。发病后30天进行脑血管造影，并在AVF引流静脉的一部分中发现了动脉瘤结构，VW-MRI最初增强了。发病后第38天,他接受了直接手术以闭塞AV瘘并解剖动脉瘤结构。组织病理学显示动脉瘤结构为静脉曲张伴淋巴细胞浸润，在静脉曲张附近观察到含铁血黄素沉积。
■最近，据报道，VW-MRI显示硬脑膜AVF静脉曲张增强与破裂病例之间存在关联。VW-MRI,特别是增强的MSDE方法，可能有助于估计动静脉分流疾病的破裂点。
■一名70岁的男子突然出现头痛。他患有格拉斯哥昏迷量表E4V5M6，世界神经外科学会联合会（WFNS）I级。在头部计算机断层扫描中发现了Fisher组3蛛网膜下腔出血和脑积水。脑血管造影显示颈椎C1水平的脊髓AVF。磁共振图像增强的运动敏化驱动平衡（MSDE方法在部分AVF引流静脉中显示出增强作用，但是这个病变的血管结构是不确定的。我们对急性脑积水和降压治疗进行了持续脑室引流。发病后30天进行脑血管造影，并在AVF引流静脉的一部分中发现了动脉瘤结构，VW-MRI最初增强了。发病后第38天,他接受了直接手术以闭塞AV瘘并解剖动脉瘤结构。组织病理学显示动脉瘤结构为静脉曲张伴淋巴细胞浸润，在静脉曲张附近观察到含铁血黄素沉积。
■最近，据报道，VW-MRI显示硬脑膜AVF静脉曲张增强与破裂病例之间存在关联。VW-MRI,特别是增强的MSDE方法，可能有助于估计动静脉分流疾病的破裂点。
