Takeshita Tomonori, Toyoda Keisuke, So Gohei, Morofuji Yoichi, Horie Nobutaka, Hayashi Kentaro, Kitagawa Naoki, Suyama Kazuhiko, Nagata Izumi
Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan.
Brain Nerve. 2011 Jun;63(6):611-5.
Abstract We report a case of a dural arteriovenous fistula (DAVF) at the tentorium cerebelli, which presented progressive myelopathy. A 68-year-old man with neurological deterioration of the cervical myelopathy visited our hospital. T weighted magnetic resonance (MR) imaging showed high signal area and edema from the medulla to the upper thoracic spinal cord with flow voids on the dorsal surface of the cord. Angiography showed right tentorial DAVF, which was supplied by the right meningohypophyseal trunk, the middle meningeal artery, the accessory meningeal artery, and was drained into the posterior spinal veins. The patient underwent right retrosigmoid suboccipital craniotomy, then disruption of the fistula was performed by using micro Doppler sonography following endovascular obliteration of the main feeders. Postoperative angiography showed complete obliteration of the fistula. His daily functioning gradually improved up to 6 months after the surgery. Tentorial DAVFs with clinical manifestation of myelopathy are rare. Considering its aggressive nature, early surgical treatment could be necessary. (Received: November 17, 2010, Accepted: December 18, 2010).
摘要 我们报告一例小脑幕硬脑膜动静脉瘘（DAVF），表现为进行性脊髓病。一名68岁患有颈髓病神经功能恶化的男性患者前来我院就诊。T加权磁共振成像显示从延髓到上胸段脊髓有高信号区和水肿，脊髓背侧有流空信号。血管造影显示右侧小脑幕DAVF，由右侧脑膜垂体干、脑膜中动脉、脑膜副动脉供血，并引流至脊髓后静脉。患者接受了右侧乙状窦后枕下开颅手术，在对主要供血支进行血管内闭塞后，使用微型多普勒超声进行瘘口阻断。术后血管造影显示瘘口完全闭塞。术后6个月他的日常功能逐渐改善。表现为脊髓病的小脑幕DAVF罕见。考虑到其侵袭性，早期手术治疗可能是必要的。（收稿日期：2010年11月17日，接受日期：2010年12月18日）
