Rennert Janine, Seiz Marcel, Nimsky Christopher, Doerfler Arnd
Department of Neuroradiology, University of Erlangen Medical School, Schwabachanlage 6, 91054 Erlangen, Germany.
Rontgenpraxis. 2008;56(5):164-8. doi: 10.1016/j.rontge.2006.10.002.
Dural arterio-venous fistulas are rare lesions. Traumatic dural AV-fistulas in particular, are very rare complications of head and neck trauma. We report on a 59-year old man with a severe facial and head trauma. Initial computed tomography demonstrated a left frontal subdural hematoma, leading to progressive midline shift. Additionally, a complex skull base fracture was present, involving the frontal, temporal and sphenoid bone. A few days after the accident the patient reported a left pulsatile tinnitus. Subsequent selective carotid angiography revealed a high flow dural arterio-venous fistula involving the middle meningeal artery and facial veins. Complete endovascular embolization was performed by a transarterial approach using microparticles and an electrolytically detachable coil resulting in an immediate disappearance of the tinnitus. Remarkably, this case nicely illustrates possible "dangerous" collateral circulation to the ophthalmic artery-a feature that should be kept in mind during endovascular treatment of this entity.
硬脑膜动静脉瘘是罕见的病变。特别是创伤性硬脑膜动静脉瘘，是头颈部创伤非常罕见的并发症。我们报告一例59岁男性，患有严重的面部和头部创伤。最初的计算机断层扫描显示左侧额部硬膜下血肿，导致中线逐渐移位。此外，存在复杂的颅底骨折，累及额骨、颞骨和蝶骨。事故发生几天后，患者报告左侧搏动性耳鸣。随后的选择性颈动脉血管造影显示，存在一个涉及脑膜中动脉和面静脉的高流量硬脑膜动静脉瘘。采用经动脉途径，使用微粒和电解可脱卸弹簧圈进行了完全血管内栓塞，耳鸣立即消失。值得注意的是，该病例很好地说明了眼动脉可能存在的“危险”侧支循环——这是在对该疾病进行血管内治疗时应牢记的一个特征。
