Nishino A, Sakurai Y, Takahashi A, Satoh H, Niizuma H, Kayama T, Mizoi K
Department of Neurosurgery, Stroke Center, Sendai National Hospital, Japan.
No To Shinkei. 1991 Jan;43(1):62-9.
A rare case of the dural AVM mainly around the left petrosal sinus was reported. A 64 years old man was admitted just after the sudden onset of severe headache and nausea. The CT scan revealed subarachnoid hemorrhage in the left ambient cisterns. A small hematoma was also found in the left cerebellar peduncle. External carotid angiogram showed a dural AVM which nidus was located adjacent to the left superior petrosal sinus. Its feeding arteries were as follows; the middle meningeal artery, the artery of foramen rotundum, the accessory meningeal artery, the dural branch of occipital artery and the ascending pharyngeal artery. The voluminous petrosal vein and the dilated cortical veins were identified as drainers and, the portion of the latter appeared as "varix" embedded in the pons, which was clearly delineated by MRI. In the venous phase, stenotic straight sinus and residual Falcine sinus were illustrated. Superselective embolization of the feeding arteries was employed followed by the direct clippings of draining vein. Postoperative course was uneventful. The present case should be classified into the tentorial dural AVM. Only 26 cases of this rarely encountered entity was reported in the literature. Based on both the present and the previously reported cases, the clinical features, treatment and pathogenesis of this disease were briefly discussed.
报告了一例罕见的主要围绕左岩下窦的硬脑膜动静脉畸形。一名64岁男性在突然出现严重头痛和恶心后入院。CT扫描显示左环池蛛网膜下腔出血。左小脑脚也发现一个小血肿。颈外动脉血管造影显示一个硬脑膜动静脉畸形，其病灶位于左岩上窦附近。其供血动脉如下：脑膜中动脉、圆孔动脉、副脑膜动脉、枕动脉脑膜支和咽升动脉。粗大的岩静脉和扩张的皮质静脉被确定为引流静脉，后者部分表现为嵌入脑桥的“静脉曲张”，MRI清晰显示。在静脉期，显示直窦狭窄和残留的大脑镰窦。采用供血动脉超选择性栓塞，随后直接夹闭引流静脉。术后过程顺利。本病例应归类为天幕硬脑膜动静脉畸形。文献中仅报道了26例这种罕见的病例。基于本病例和先前报道的病例，简要讨论了该疾病的临床特征、治疗和发病机制。
