Department of Radiology, Severance Hospital; and.
J Neurosurg. 2013 Oct;119(4):955-60. doi: 10.3171/2013.4.JNS121974. Epub 2013 May 31.
The purpose of this study was to evaluate the incidence, radiographic findings, relationship between presenting symptoms for treatment and drainage pattern, and treatment outcomes of hypoglossal canal dural arteriovenous fistula (HC-dAVF).
During a 16-year period, 238 patients underwent endovascular treatment for cranial dAVF at a single center. The incidence, radiographic findings, relationship between presenting symptoms for treatment and drainage pattern, and treatment outcomes of HC-dAVF were retrospectively evaluated.
The incidence of HC-dAVF was 4.2% (n = 10). Initial symptoms were tinnitus with headache (n = 6), tinnitus only (n = 1), ocular symptoms (n = 1), otalgia (n = 1), and congestive myelopathy (n = 1). Presenting symptoms requiring treatment included ocular symptoms (n = 4), hypoglossal nerve palsy (n = 4), aggravation of myelopathy (n = 1), and aggravation of tinnitus with headache (n = 1). While the affected HC was widened in 4 of 10 patients, hypersignal intensity on source images was conspicuous in all 7 patients who underwent MR angiography (MRA). All ocular symptoms and congestive myelopathy were associated with predominant drainage to superior ophthalmic or perimedullary veins due to antegrade drainage restriction. All patients who underwent transvenous coil embolization (n = 8) or transarterial N-butyl cyanoacrylate (NBCA) embolization (n = 1) improved without recurrence. One patient who underwent transarterial particle embolization had a recurrence 12 months posttreatment and was retreated with transvenous embolization.
The incidence of HC-dAVF was 4.2% of all cranial dAVF patients who underwent endovascular treatment. Source images of MRA helped to accurately diagnose HC-dAVF. More aggressive symptoms may develop as a result of a change in the predominant drainage route due to the development of venous stenosis or obstruction over time. Transvenous coil embolization appears to be the first treatment of choice.
本研究旨在评估舌下神经管硬脑膜动静脉瘘（HC-dAVF）的发生率、影像学表现、治疗症状与引流方式的关系，以及治疗结果。
在一个 16 年的时间段内，在一家单中心对 238 例颅脑血管动静脉瘘患者进行了血管内治疗。回顾性评估了 HC-dAVF 的发生率、影像学表现、治疗症状与引流方式的关系，以及治疗结果。
HC-dAVF 的发生率为 4.2%（n=10）。初始症状包括耳鸣伴头痛（n=6）、仅耳鸣（n=1）、眼部症状（n=1）、耳痛（n=1）和充血性脊髓病（n=1）。需要治疗的症状包括眼部症状（n=4）、舌下神经麻痹（n=4）、脊髓病加重（n=1）和耳鸣伴头痛加重（n=1）。尽管 10 例患者中有 4 例 HC 增宽，但在接受磁共振血管造影（MRA）的 7 例患者中，源图像上的高信号强度都很明显。所有眼部症状和充血性脊髓病都与由于前向引流受限导致的主要向眼上或脊髓旁静脉引流有关。所有接受静脉内线圈栓塞（n=8）或动脉内 N-丁基氰基丙烯酸酯（NBCA）栓塞（n=1）的患者均无复发且症状改善。1 例接受动脉内颗粒栓塞的患者在治疗后 12 个月复发，并再次接受静脉内栓塞治疗。
在接受血管内治疗的所有颅脑血管动静脉瘘患者中，HC-dAVF 的发生率为 4.2%。MRA 的源图像有助于准确诊断 HC-dAVF。随着时间的推移，静脉狭窄或阻塞导致主要引流途径发生变化，可能会出现更严重的症状。静脉内线圈栓塞似乎是首选的治疗方法。
