Ohnishi Hiroyuki, Deguchi Jun, Yamada Makoto, Kuroiwa Toshihiko
Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-cho, Takatuki-city, Osaka 569-8686, Japan.
No Shinkei Geka. 2003 Oct;31(10):1119-23.
Intracranial dural arteriovenous fistula (DAVF) rarely presents with myelopathy. We discuss the diagnosis and treatment of this entity. A 76-year-old woman presented with tetraparesis and sphincter dysfunction. Magnetic resonance imaging demonstrated a high signal intensity from the medulla oblongata to the upper cervical cord on T2-weighted images. Angiograms showed a cavernous DAVF and venous drainage to perimedullary spinal veins via the petrosal vein. It was concluded that, myelopathy had resulted from congestion of the spinal veins. Transarterial embolization of the left cavernous sinus was performed through the left sphenopalatine artery with 25% NBCA after another feeding artery had been occluded using fiber coils. The patient's tetraparesis and sphincter dysfunction gradually improved after embolization, while the high signal intensity on T2-weighted images disappeared within two months after treatment. We should take intracranial DAVF into consideration in patients with myelopathy of unknown origin.
颅内硬脑膜动静脉瘘（DAVF）很少表现为脊髓病。我们讨论该疾病的诊断和治疗。一名76岁女性出现四肢轻瘫和括约肌功能障碍。磁共振成像显示在T2加权图像上从延髓到颈上段脊髓呈高信号强度。血管造影显示海绵窦DAVF并通过岩静脉向脊髓周围静脉引流。结论是，脊髓病是由脊髓静脉充血引起的。在使用纤维圈闭塞另一供血动脉后，通过左蝶腭动脉用25%的NBCA对左海绵窦进行经动脉栓塞。栓塞后患者的四肢轻瘫和括约肌功能障碍逐渐改善，而T2加权图像上的高信号强度在治疗后两个月内消失。对于病因不明的脊髓病患者，应考虑颅内DAVF。
