Lesley W S
The Texas A&M University System, Health Science Center, College of Medicine, Scott & White Memorial Hospital, Scott, Sherwood and Brindley Foundation, Temple, Texas, USA.
J Neurosurg Sci. 2007 Dec;51(4):177-80.
A 56-year-old woman with right-sided trigeminal neuralgia (TN), who underwent technically uneventful percutaneous balloon rhizotomy, developed significant bilateral pulsatile tinnitus on the first post-operative day. Although the patient reported significantly improved neuralgia, auscultation revealed a right facial bruit. Magnetic resonance angiography (MRA) of the face and brain demonstrated prominent right facial and jugular venous vascularity. Catheter angiography confirmed the suspected facial arteriovenous fistula (AVF). A transarterial approach was used to explore the AVF which arose from a laceration of the right internal maxillary artery and which fistulized directly with the pterygoid venous plexus. Endosurgical repair utilizing three non-fibered platinum coils was done under conscious sedation at the same setting as the diagnostic angiogram. Angiographically, the fistula was obliterated, and the patient's bruit and tinnitus immediately resolved. Follow-up MRA at 3.5 months was normal, and, the patient had no clinical symptoms of recurrent AVF. In conclusion facial AVF can complicate percutaneous trigeminal rhizotomy. Iatrogenic facial AVF can be repaired via an endovascular approach.
一名56岁患有右侧三叉神经痛（TN）的女性，接受了技术上顺利的经皮球囊三叉神经半月节切断术，术后第一天出现了明显的双侧搏动性耳鸣。尽管患者报告神经痛明显改善，但听诊发现右侧面部有杂音。面部和脑部的磁共振血管造影（MRA）显示右侧面部和颈静脉血管明显增多。导管血管造影证实了疑似面部动静脉瘘（AVF）。采用经动脉方法探查AVF，其起源于右侧上颌内动脉的撕裂，并直接与翼静脉丛形成瘘管。在与诊断性血管造影相同的环境下，在清醒镇静状态下使用三个无纤维铂金线圈进行了内镜手术修复。血管造影显示瘘管闭塞，患者的杂音和耳鸣立即消失。3.5个月后的随访MRA正常，患者没有复发性AVF的临床症状。总之，面部AVF可使经皮三叉神经切断术复杂化。医源性面部AVF可通过血管内方法修复。
