Kim Myoung Soo, Han Dae Hee, Kwon O-Ki, Oh Chang-Wan, Han Moon Hee
Department of Neurosurgery, Seoul National University College of Medicine, Korea.
J Clin Neurosci. 2002 Mar;9(2):147-55. doi: 10.1054/jocn.2001.1029.
Intracranial dural arteriovenous fistula (DAVF) is an uncommon neurosurgical condition; in particular, it has been infrequently reported in Korea. To understand the general clinical characteristics of DAVFs, the authors reviewed 53 cases and analyzed factors affecting DAVF hemorrhage of and treatment outcome. Since 1980 we have encountered 480 pial and 53 DAVFs, a ratio of 9.1 to 1. The age of these patients ranged from 1 month to 71 years, the most common being in the 6th decade, and females exceeded males by 1.65 to 1. All lesions except three were single, and symptoms were related to location and the venous drainage pattern. The most common location was the cavernous sinus, accounting for about 64% of cases, with the result that the most common clinical symptoms of DAVFs were ocular, namely proptosis and chemosis. The next was tinnitus also found in transverse-sigmoid sinus DAVFs. Intracranial hemorrhage was seen in eight cases,(15%) the primary cause of hemorrhage was retrograde intracranial venous drainage (P=0.017), and one hemorrhage was observed in cases with no intracranial venous drainage. Intracranial hemorrhage was more frequently in transverse-sigmoid than cavernous sinus DAVFs (P=0.049), and this proved to be so even where there was intracranial venous drainage. However, two of 34 patients with cavernous DAVFs became blind in one eye, demonstrating that in such patients, the clinical course could be aggressive. Thirteen patients were treated conservatively. The conservative treatment group was comprised of 13 patients, two of three patients with transverse-sigmoid sinus DAVF expired, and 7 of 10 with cavernous sinus DAVF experienced a clinical improvement or cure. Surgical excision was performed in only two patients. A total of 39 patients underwent embolization; clinical cure was achieved in 13, improvement of symptoms in 12, an unchanged or aggravated result occurred in 9, one died, and four were lost to follow up. During intervention, there was one hemorrhagic complication, owing to obstruction of the venous outflow with embolic materials. In this study, the most common location of DAVFs was the cavernous sinus. The cortical venous drainage remains the primary determinant of intracranial hemorrhage. Common indications for treatment include hemorrhage and neurological deficit. Endovascular treatment is preferred in the majority of cases except tentorial DAVF. The goal of embolization in cavernous DAVF is the alleviation of symptoms, not angiographic cure. But transverse-sigmoid sinus DAVF with venous restriction and leptomeningeal drainage should be treated aggressively.
颅内硬脑膜动静脉瘘（DAVF）是一种罕见的神经外科疾病；尤其是在韩国，相关报道较少。为了解DAVF的一般临床特征，作者回顾了53例病例，并分析了影响DAVF出血及治疗结果的因素。自1980年以来，我们共诊治了480例软脑膜动静脉瘘和53例DAVF，比例为9.1比1。这些患者的年龄从1个月至71岁不等，最常见于60岁左右，女性与男性的比例为1.65比1。除3例病变外，所有病变均为单发，症状与病变位置及静脉引流方式有关。最常见的位置是海绵窦，约占病例的64%，因此DAVF最常见的临床症状是眼部症状，即眼球突出和结膜水肿。其次是耳鸣，也见于横窦-乙状窦DAVF。8例（15%）出现颅内出血，出血的主要原因是颅内静脉逆流（P = 0.017），1例颅内无静脉引流的病例出现了出血。横窦-乙状窦DAVF比海绵窦DAVF更容易发生颅内出血（P = 0.049），即使存在颅内静脉引流也是如此。然而，34例海绵窦DAVF患者中有2例单眼失明，表明此类患者的临床病程可能较为凶险。13例患者接受了保守治疗。保守治疗组由13例患者组成，3例横窦-乙状窦DAVF患者中有2例死亡，10例海绵窦DAVF患者中有7例临床症状改善或治愈。仅2例患者接受了手术切除。共有39例患者接受了栓塞治疗；13例临床治愈，12例症状改善，9例病情无变化或加重，1例死亡，4例失访。在介入治疗过程中，发生了1例出血并发症，原因是栓塞材料阻塞了静脉流出道。在本研究中，DAVF最常见的位置是海绵窦。皮质静脉引流仍然是颅内出血的主要决定因素。常见的治疗适应证包括出血和神经功能缺损。除天幕DAVF外，大多数病例首选血管内治疗。海绵窦DAVF栓塞的目标是缓解症状，而非血管造影治愈。但对于伴有静脉狭窄和软脑膜引流的横窦-乙状窦DAVF应积极治疗。
