Tsumoto T, Nakakita K, Hayashi S, Terada T
Department of Neurosurgery, Minami Wakayama National Hospital, Tanabe, Wakayama.
Neurol Med Chir (Tokyo). 2001 Jan;41(1):42-7. doi: 10.2176/nmc.41.42.
A 57-year-old male presented with a frontal bone defect associated with a middle meningeal arteriovenous fistula (AVF) manifesting as headache. The patient had a history of head injury 19 years previously. Skull radiography and computed tomography demonstrated a left frontal bone defect. Left external carotid angiography demonstrated a middle meningeal AVF at the frontal region, at the same location as the bone defect. The AVF was fed by the bilateral middle meningeal and left deep temporal arteries, and drained by the superior sagittal and ipsilateral cavernous sinuses. The minor feeding artery, the left deep temporal artery, was embolized with polyvinyl alcohol particles, then 0.4 ml of a 1:3 mixture of n-butyl cyanoacrylate and lipiodol was injected from the left middle meningeal artery. Follow-up angiography 3 months after the embolization revealed complete obliteration of the fistula. The bone defect may have been caused by erosion of the frontal bone by the pulsating effect of the feeding and draining vessels of the fistula, or by inadequate nutrition to the bone tissue because of the arteriovenous shunt.
一名57岁男性因额骨缺损伴中脑膜动静脉瘘（AVF）就诊，表现为头痛。该患者19年前有头部受伤史。颅骨X线摄影和计算机断层扫描显示左额骨缺损。左颈外动脉血管造影显示额部区域存在中脑膜AVF，与骨缺损位于同一位置。该AVF由双侧中脑膜动脉和左颞深动脉供血，经上矢状窦和同侧海绵窦引流。较小的供血动脉，即左颞深动脉，用聚乙烯醇颗粒进行栓塞，然后从左中脑膜动脉注入0.4毫升正丁基氰基丙烯酸酯与碘油的1:3混合物。栓塞后3个月的随访血管造影显示瘘管完全闭塞。骨缺损可能是由于瘘管供血和引流血管的搏动作用侵蚀额骨，或因动静脉分流导致骨组织营养不足所致。
