Fiumara Ettore, Tumbiolo Silvana, Bellomonte Maria Luisa, Savatteri Paolino, Finazzo Francesca, La Gattuta Fabio
Department of Neurosurgery, Villa Sofia Hospital, Palermo, Italy.
J Neurosurg. 2004 Feb;100(2):348-52. doi: 10.3171/jns.2004.100.2.0348.
Dural arteriovenous fistulas (DAVFs) occurring simultaneously at two or more separate locations are not frequent. In fact, the incidence of multiple DAVFs is 7 to 8% of all DAVFs. Patients harboring multiple DAVFs have a higher incidence of hemorrhage, venous infarction, and neurological deficits due to a greater frequency of leptomeningeal venous drainage. To the authors' knowledge only a few cases of DAVFs involving both transverse sinuses (TSs) have been reported. These patients underwent various combined treatments (transarterial embolization, transvenous obliteration, surgical isolation, resection, and radiosurgery). Treatments performed that do not include resection of the involved sinuses do not always guarantee a cure. The authors present a patient who harbored multiple DAVFs of the TSs, both distally occluded with secondary reflux into the superior sagittal sinus (SSS), the straight sinus, the deep venous system, and the leptomeningeal veins of both hemispheres. An en bloc removal of the portions including the fistulas of the TSs, the confluence of sinuses, and the distal parts of the SSS, and straight sinus allowed for the patient to be cured. The fact is emphasized that despite the progress of endovascular treatment and radiosurgery this kind of DAVF must be surgically treated. The operation may be complex and dangerous.
硬脑膜动静脉瘘（DAVF）同时发生在两个或更多不同部位的情况并不常见。事实上，多发性DAVF的发生率占所有DAVF的7%至8%。患有多发性DAVF的患者出血、静脉梗死以及神经功能缺损的发生率较高，原因是软脑膜静脉引流的频率更高。据作者所知，仅有少数累及双侧横窦（TS）的DAVF病例被报道。这些患者接受了各种联合治疗（经动脉栓塞、经静脉闭塞、手术孤立、切除以及放射外科治疗）。未包括切除受累窦的治疗方法并不总能保证治愈。作者介绍了一名患有双侧TS多发性DAVF的患者，双侧TS均在远端闭塞，并继发血液反流至上矢状窦（SSS）、直窦、深部静脉系统以及双侧半球的软脑膜静脉。整块切除包括TS瘘、窦汇以及SSS和直窦远端部分，使患者得以治愈。需要强调的是，尽管血管内治疗和放射外科取得了进展，但这种类型的DAVF仍必须接受手术治疗。该手术可能复杂且危险。
