Masuoka Jun, Sakata Shuji, Maeda Kenji, Matsushima Toshio
Department of Neurosurgery, Saga University School of Medicine, Saga, Japan.
J Neurosurg. 2008 Sep;109(3):497-501. doi: 10.3171/JNS/2008/109/9/0497.
The authors report a rare case of pial single-channel arteriovenous fistula presenting with significant brain edema. A 51-year-old woman was admitted with a 5-day history of headache and nausea, followed by consciousness disturbance. Computed tomography showed cerebellar swelling with obstructive hydrocephalus. Magnetic resonance imaging revealed extensive vasogenic edema in the cerebellum bilaterally. Angiography demonstrated 2 different arteriovenous shunts (AVSs) at peripheral branches of the right anterior inferior cerebellar artery. One was located on the suboccipital surface. It drained through a dilated inferior vermian vein and emptied retrogradely into the contralateral cerebellar veins with marked stagnation. Focal stenosis of the dilated draining vein was present. The other AVS was located on the petrosal surface, which had a slow flow with no angiographic evidence of venous congestion. Given that the latter was believed to be asymptomatic, the former AVS was excised, and histological examination revealed that the lesion consisted of a direct communication of multiple arterial feeding vessels with a single vein, consistent with a diagnosis of pial single-channel arteriovenous fistula. The restriction of venous drainage presumably caused venous hypertension, leading to the brain edema and neurological symptoms.
作者报告了一例罕见的软膜单通道动静脉瘘伴显著脑水肿的病例。一名51岁女性因头痛和恶心5天入院，随后出现意识障碍。计算机断层扫描显示小脑肿胀伴梗阻性脑积水。磁共振成像显示双侧小脑广泛血管源性水肿。血管造影显示右小脑前下动脉外周分支有2处不同的动静脉分流（AVS）。一处位于枕下表面，通过扩张的小脑蚓部下静脉引流，逆行汇入对侧小脑静脉，有明显的血流停滞，扩张的引流静脉存在局灶性狭窄。另一处AVS位于岩骨表面，血流缓慢，血管造影无静脉淤血证据。鉴于后者被认为无症状，切除了前者的AVS，组织学检查显示病变由多条动脉供血血管与单一静脉直接相通组成，符合软膜单通道动静脉瘘的诊断。静脉引流受限可能导致静脉高压，进而引起脑水肿和神经症状。
