Yang Ming, Pan Li, Cai Ming-Jun, Ma Lian-Ting, Xu Guo-Zheng, Li Jun, Chen Gang, Wu Jie, Huang Sheng-Yao, Wen Yu-Xing
Department of Neurosurgery, Wuhan General Hospital, Guangzhou Military Command of PLA, Wuhan, PR China.
Department of Neurosurgery, Wuhan General Hospital, Guangzhou Military Command of PLA, Wuhan, PR China; Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, PR China.
Clin Neurol Neurosurg. 2014 Aug;123:18-24. doi: 10.1016/j.clineuro.2014.05.001. Epub 2014 May 14.
Despite the increasing reports of traumatic and iatrogenic arteriovenous fistulas (AVFs) of the superficial temporal artery (STA), the spontaneous origination of fistulas is extremely rare, and very little is known about their natural development. Spontaneous AVFs of the STA have the characteristic findings of an expanding, painless pulsatile mass and a palpable thrill with or without a vascular murmur.
This article describes five patients with AVFs of the STA with no history of a head injury. Four of them were treated successfully either by surgical resection or by endovascular embolization. These five illustrative cases with their medium-term follow-up results are reported.
In two patients, we successfully used a single-balloon alone to occlude the fistula without any complications; the patients experienced no recurrences during the clinical follow-up. In the other two patients, we carefully identified and ligated all of the involved feeding arteries and draining veins, which was followed by an excision of the lesion. At the 6-month follow-up, the patients were doing very well, with no evidence of AVF recurrences or new neurological complaints.
AVFs of the STA can be detected via a computed tomography angiogram (CTA) or by intra-arterial angiography alone. Intra-arterial angiography, however, remains the definitive type of investigation. AVF may be treated either by surgical ligation and excision under a local or general anesthetic or by endovascular embolization. The former modality has been the most common method of treating the lesion in the vast majority of reports. However, endovascular embolization also appears to be suitable for treating this condition.
尽管颞浅动脉（STA）创伤性和医源性动静脉瘘（AVF）的报道日益增多，但瘘的自发形成极为罕见，对其自然发展了解甚少。STA的自发性AVF具有扩张性、无痛性搏动性肿块以及可触及震颤（伴有或不伴有血管杂音）的特征性表现。
本文描述了5例无头部受伤史的STA的AVF患者。其中4例通过手术切除或血管内栓塞成功治疗。报告了这5例具有中期随访结果的说明性病例。
在2例患者中，我们仅成功使用单个球囊闭塞瘘，无任何并发症；患者在临床随访期间无复发。在另外2例患者中，我们仔细识别并结扎了所有受累的供血动脉和引流静脉，随后切除病变。在6个月的随访中，患者情况良好，无AVF复发或新的神经症状。
STA的AVF可通过计算机断层血管造影（CTA）或仅通过动脉内血管造影检测。然而，动脉内血管造影仍是确定性的检查类型。AVF可通过局部或全身麻醉下的手术结扎和切除或血管内栓塞治疗。在绝大多数报告中，前一种方式一直是治疗该病变最常用的方法。然而，血管内栓塞似乎也适用于治疗这种情况。
