Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
World Neurosurg. 2010 Apr;73(4):385-90. doi: 10.1016/j.wneu.2010.01.023.
Pial arteriovenous fistula is a rare disease and surgical treatment for these lesions is difficult. We present our clinical outcomes of endovascular treatment for intracranial pial arteriovenous fistula (AVF).
We reviewed the clinical and radiologic data of 16 patients with intracranial pial AVFs who were treated endovascularly at the Beijing Tiantan Hospital between 1998 and 2008.
Six patients presented with intracranial hemorrhage, six presented with headaches, two with seizures, one with neurologic deficit, and one with transient ischemic attack. Cerebral angiograms showed that these pial AVFs were supplied by the middle cerebral artery (n = 6), the anterior cerebral artery (n = 4), the posterior cerebral artery (n = 3), the basilar artery (n = 2), and the inferoposterior cerebellar artery (n = 1). All AVFs were associated with large venous varices. One of the lesions had two associated feeding artery aneurysms. The venous drainage was deep in 11 lesions. All AVFs were embolized transarterially through the feeding arteries. Coils was used in 14 patients with a combination of liquid embolic agent (n-butyl cyanoacrylate and Onyx [Micro Therapeutics Inc., Irvine, CA]) in five patients; Onyx was used in three patients. Immediate complete angiographic obliteration was achieved in 13 patients. Three patients incompletely treated with coils showed complete obliteration at follow-up. Twelve patients experienced an angiographic and clinical cure without any complications at 3 months. Three patients (18.75%) experienced hydrocephalus after the procedure caused by venous thrombosis. Glasgow outcome scores were good in 15 patients (93.75%) and poor in 1 patient (6.2%) at follow-up.
Transarterial embolization of the arterial feeders using coils and/or liquid embolic agents may be a good treatment for pial AVFs. Hydrocephalus caused by venous thrombosis is the main complication.
脑动静脉瘘是一种罕见疾病，其病变的手术治疗极具难度。我们在此报告经血管内治疗颅内脑动静脉瘘（AVF）的临床结果。
我们回顾了 1998 年至 2008 年在北京天坛医院接受血管内治疗的 16 例颅内脑动静脉瘘患者的临床和影像学资料。
6 例患者表现为颅内出血，6 例表现为头痛，2 例表现为癫痫，1 例表现为神经功能缺损，1 例表现为短暂性脑缺血发作。脑血管造影显示，这些脑动静脉瘘由大脑中动脉（n = 6）、大脑前动脉（n = 4）、大脑后动脉（n = 3）、基底动脉（n = 2）和小脑后下动脉（n = 1）供血。所有动静脉瘘均伴有大静脉瘤。1 例病变有 2 个相关供血动脉动脉瘤。11 例病变静脉引流较深。所有动静脉瘘均通过供血动脉经动脉栓塞。14 例患者使用线圈栓塞，5 例患者联合使用液体栓塞剂（n-丁基氰基丙烯酸酯和 Onyx[Micro Therapeutics Inc.，Irvine，CA]），3 例患者使用 Onyx。13 例患者即刻完全闭塞造影。3 例经线圈不完全治疗的患者随访时完全闭塞。12 例患者在 3 个月时出现血管造影和临床治愈，无任何并发症。3 例患者（18.75%）术后因静脉血栓形成导致脑积水。15 例患者（93.75%）格拉斯哥预后评分良好，1 例患者（6.2%）预后较差。
使用线圈和/或液体栓塞剂经动脉栓塞供血动脉可能是治疗脑动静脉瘘的一种较好方法。静脉血栓形成引起的脑积水是主要并发症。
