Takazawa Hiroki, Kubo Michiya, Kuwayama Naoya, Hasegawa Shinsaku, Horie Yukio, Hirashima Yutaka, Endo Shunro
Department of Neurosurgery, Toyama Medical and Pharmaceutical University, Japan.
No Shinkei Geka. 2005 Feb;33(2):143-7.
A case of cavernous sinus dural arteriovenous fistula (CS-DAVF) presenting intracerebral venous hemorrhage was reported. An 81-year-old woman was suffered from generalized convulsion accompanied by right conjunctival hyperemia and edema. Computed tomography scan revealed intracerebral hematoma involving right putamen and perifocal edema extraordinarily expanded to inferior part of the right frontal lobe and insular cortex. Cerebral angiography showed a CS-DAVF with retrograde leptomeningeal venous drainage (RLVD) not only to superficial middle cerebral vein but to basal vein of Rosenthal (BVR). Transvenous embolization was performed using mechanically detachable coils and free fibered platinum coils. After embolization, RLVD disappeared and conjunctival symptoms were improved. Hemorrhagic risk of this patient was discussed, based on her angiographical findings. We speculated that deep venous drainage to BVR through uncal vein, in case with poor venous collateral geometry, is one of the risk factor of cerebral hemorrhage.
报道了一例海绵窦硬脑膜动静脉瘘（CS-DAVF）伴脑内静脉出血的病例。一名81岁女性出现全身惊厥，伴有右侧结膜充血和水肿。计算机断层扫描显示脑内血肿累及右侧壳核，病灶周围水肿异常扩展至右侧额叶下部和岛叶皮质。脑血管造影显示一个CS-DAVF，其不仅向大脑中浅静脉有逆行软脑膜静脉引流（RLVD），还向罗森塔尔基底静脉（BVR）有引流。使用机械可脱卸弹簧圈和游离纤维铂弹簧圈进行经静脉栓塞。栓塞后，RLVD消失，结膜症状改善。根据该患者的血管造影结果讨论了其出血风险。我们推测，在静脉侧支几何形态不佳的情况下，通过钩静脉向BVR的深静脉引流是脑出血的危险因素之一。
