Feroze Abdullah H, Kushkuley Jacob, Choudhri Omar, Heit Jeremy J, Steinberg Gary K, Do Huy M
*Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; ‡Department of Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts.
Neurosurgery. 2015 Mar;11 Suppl 2:E202-6. doi: 10.1227/NEU.0000000000000558.
Moyamoya disease is a rare cerebrovascular disorder often treated by direct and indirect revascularization bypass techniques as a result of a typically devastating disease course and poor response to medical therapy. In this report, we describe the formation and subsequent management of a de novo arteriovenous fistula identified in the setting of a patient treated with direct bypass surgery, a previously unreported phenomenon.
A 51-year-old woman presenting with Suzuki stage IV bilateral moyamoya disease underwent bilateral extracranial-to-intracranial superficial temporal artery-to-middle cerebral artery bypass without complication at our institution. At the 6-month follow-up, she demonstrated no evidence of residual neurological deficits or continued symptoms despite documentation of an arteriovenous fistula arising at the site of the right extracranial-to-intracranial bypass on routine follow-up cerebral angiography.
We present the first reported case of de novo arteriovenous fistula formation after superficial temporal artery-to-middle cerebral artery bypass for the treatment of moyamoya disease. Treatment of such iatrogenic arteriovenous fistulae fed by a patent bypass vessel may prove challenging without associated compromise of the bypass, meriting careful evaluation of all potential therapeutic options. The fistula described herein most likely occurred secondary to recanalization of a previously thrombosed vein of Trolard. This case demonstrates the possibility of arteriovenous fistula formation as a potential sequela of revascularization bypass surgery and lends support to the previously described traumatic origin of fistula formation.
烟雾病是一种罕见的脑血管疾病，由于其典型的严重病程及对药物治疗反应不佳，常采用直接和间接血管重建旁路技术进行治疗。在本报告中，我们描述了在一名接受直接旁路手术的患者中发现的新生动静脉瘘的形成及后续处理，这是一种此前未报道过的现象。
一名51岁患有铃木IV期双侧烟雾病的女性在我院接受了双侧颞浅动脉至大脑中动脉的颅外-颅内旁路手术，未出现并发症。在6个月的随访中，尽管在常规随访脑血管造影中记录到右侧颅外-颅内旁路部位出现动静脉瘘，但她没有残留神经功能缺损或持续症状的证据。
我们报告了首例烟雾病患者在接受颞浅动脉至大脑中动脉旁路手术后出现新生动静脉瘘的病例。在不影响旁路的情况下，治疗由通畅的旁路血管供血的此类医源性动静脉瘘可能具有挑战性，值得仔细评估所有潜在的治疗选择。本文所述的瘘管很可能是由于先前已血栓形成的Trolard静脉再通所致。该病例证明了动静脉瘘形成作为血管重建旁路手术潜在后遗症的可能性，并支持了先前描述的瘘管形成的创伤性起源。
