Iwamuro Yasushi, Nakahara Ichiro, Higashi Toshio, Iwaasa Mitsutoshi, Watanabe Yoshihiko, Hirata Eishu, Tsunetoshi Kenzo, Taha Mahmoud
Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka 802-003, Japan.
Surg Neurol. 2006 May;65(5):511-5. doi: 10.1016/j.surneu.2005.07.076.
Tentorial dural arteriovenous fistula (AVF) presented symptoms due to mass effect on the dilated draining vein. We report a patient presenting left hemisensory disturbance because of compression of the midbrain by a dilated draining vein of the AVF. The AVF has disappeared completely by drainer clipping after feeder embolization.
A 66-year-old woman presented with left hemisensory disturbance due to compression of the midbrain by a dilated draining vein with tentorial dural AVF. On admission, she complained of left hemisensory disturbance. Enhanced computed tomography (CT), magnetic resonance imaging, and magnetic resonance angiogram revealed the midbrain compressed by a mass lesion, which was a draining vein with AVF fed by numerous feeding arteries neighboring the right tentorial edge. The single-photon emission CT (SPECT) did not depict any laterality.
This is a rare case of a tentorial dural AVF which caused left hemisensory disturbance not by venous congestion, but by a compression of the midbrain by the dilated draining vein, because SPECT showed no laterality. In this case, magnetic resonance angiogram, 3-dimensional CT angiography, and SPECT were useful in the diagnosis and planning the strategy for treatment.
小脑幕硬脑膜动静脉瘘（AVF）因扩张的引流静脉产生占位效应而出现症状。我们报告1例患者，其因AVF扩张的引流静脉压迫中脑而出现左侧半身感觉障碍。在供血动脉栓塞后通过夹闭引流静脉，AVF已完全消失。
1例66岁女性因小脑幕硬脑膜AVF扩张的引流静脉压迫中脑而出现左侧半身感觉障碍。入院时，她主诉左侧半身感觉障碍。增强计算机断层扫描（CT）、磁共振成像和磁共振血管造影显示中脑被一个占位性病变压迫，该病变为一条引流静脉，有AVF，由邻近右侧小脑幕边缘的众多供血动脉供血。单光子发射CT（SPECT）未显示任何偏侧性。
这是1例罕见的小脑幕硬脑膜AVF病例，其导致左侧半身感觉障碍并非由于静脉淤血，而是由于扩张的引流静脉压迫中脑，因为SPECT未显示偏侧性。在此病例中，磁共振血管造影、三维CT血管造影和SPECT对诊断及制定治疗策略很有用。
