Shen Shih-Chieh, Tsuei Yuang-Seng, Chen Wen-Hsien, Shen Chiung-Chyi
Department of Neurosurgery, Triservice General Hospital Songshan Branch, Taiwan Department of Neurosurgery, Taichung Veterans General Hospital, Taiwan.
Department of Neurosurgery, Taichung Veterans General Hospital, Taiwan Department of Neurosurgery, Triservice General Hospital, National Defense Medical Center, Taiwan.
J Neurointerv Surg. 2015 Feb;7(2):e6. doi: 10.1136/neurintsurg-2013-011060.rep. Epub 2014 Jan 31.
Treatment of a dural arteriovenous fistula (AVF), which is difficult to access by either the surgical or endovascular approach, is challenging. A hybrid technique, combining a microsurgical approach and endovascular embolization, can provide less invasive management of dural AVFs in a modern neurosurgical hybrid operating suite. We present a case of intracerebral hemorrhage in the left cerebellum secondary to dural AVF, Cognard type IV with numerous tiny feeders from the ascending pharyngeal artery branches. No adequate arterial or venous route for endovascular embolization was found by neuroangiography. The hybrid technique, combining keyhole pterional craniotomy and embolization with n-butyl cyanoacrylate glue injection via direct cannulation of the periclival venous plexus, succeeded in obliterating the dural AVF. Intraoperative angiography showed successful embolization of the dural AVF without any complication. This report illustrates the usefulness of the neurosurgical hybrid operating suite for the treatment of difficult dural AVFs.
治疗硬脑膜动静脉瘘（AVF）具有挑战性，因为其难以通过手术或血管内途径进行处理。一种将显微手术方法与血管内栓塞相结合的混合技术，可在现代神经外科混合手术室中对硬脑膜AVF进行侵入性较小的治疗。我们报告一例继发于硬脑膜AVF的左小脑脑出血病例，该病例为Cognard IV型，有来自咽升动脉分支的众多微小供血支。神经血管造影未发现适合血管内栓塞的动脉或静脉途径。通过锁孔翼点开颅术并经海绵窦周围静脉丛直接插管注入正丁基氰基丙烯酸酯胶水进行栓塞的混合技术成功闭塞了硬脑膜AVF。术中血管造影显示硬脑膜AVF成功栓塞且无任何并发症。本报告说明了神经外科混合手术室在治疗难治性硬脑膜AVF方面的实用性。
