Morikawa T, Yasui T, Komiyama M, Iwai Y, Yamanaka K, Nishikawa M, Nakajima H, Kishi H
Department of Neurosurgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
No Shinkei Geka. 2000 Nov;28(11):1009-14.
Dural arteriovenous fistulae (DAVF's) in the anterior cranial fossa are uncommon. We encountered three patients with DAVF's in the anterior cranial fossa and reviewed the pertinent literature with regard to the etiology. All patients are middle-aged males. Two of three patients had massive intracranial hemorrhage, subarachnoidal hemorrhage in one and subdural hemorrhage in the other. One patient had a ruptured middle cerebral artery aneurysm and DAVF at the anterior cranial fossa was detected only incidentally. Angiographically, blood supplies were from the bilateral enlarged anterior ethmoidal arteries. These drained into the superior sagittal sinus via dilated frontal cortical veins. In all the patients, coagulation of the fistulous connections was carried out and the postoperative courses were uneventful. Angiographies revealed complete disappearance of the DAVF's. In conclusion, compared to cases of DAVF's in the other locations, DAVF's of the anterior cranial fossa are more likely to be brought on by sudden massive intracranial hemorrhage, and should be treated, even if asymptomatic, at the time of diagnosis. Surgical obliteration of the fistulous connection is sufficient treatment for DAVF in the anterior cranial fossa. Literature review strongly suggests that DAVF's involving the anterior cranial fossa are acquired lesions.
前颅窝硬脑膜动静脉瘘(DAVF)并不常见。我们遇到了3例前颅窝DAVF患者,并就病因对相关文献进行了回顾。所有患者均为中年男性。3例患者中有2例发生了大量颅内出血,其中1例为蛛网膜下腔出血,另1例为硬膜下出血。1例患者患有大脑中动脉动脉瘤破裂,前颅窝DAVF仅偶然被发现。血管造影显示,供血来自双侧增粗的筛前动脉。这些血液通过扩张的额叶皮质静脉流入上矢状窦。所有患者均进行了瘘口封堵,术后病程顺利。血管造影显示DAVF完全消失。总之,与其他部位的DAVF病例相比,前颅窝DAVF更易由突然大量颅内出血引起,即使无症状,在诊断时也应进行治疗。手术闭塞瘘口对前颅窝DAVF来说是足够的治疗方法。文献回顾强烈提示,累及前颅窝的DAVF是后天性病变。