Baltsavias Gerasimos, Kumar Rahul, Avinash K M, Valavanis Anton
Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland,
Neurosurg Rev. 2015 Apr;38(2):265-71; discussion 272. doi: 10.1007/s10143-014-0594-y. Epub 2014 Nov 19.
Leptomeningeal venous drainage of cranial dural arteriovenous fistulae is the most important determinant of adverse clinical course. Factors that predispose to its occurrence have not been adequately addressed in the literature. In the present study, we investigated the relation of shunt location to the development of leptomeningeal venous drainage, with regard to the bridging veins. Angiographic data of 211 consecutive patients with cranial dural arteriovenous fistulae treated over 19 years were analyzed. Dural shunts with leptomeningeal venous drainage were found in 107 patients; of these, 71 patients had pure leptomeningeal venous drainage (Borden type 3). The angioarchitecture of the shunt, including pattern of arterial feeders, relation with the bridging veins, primary venous drainage, and venous outflow restrictions were recorded. After analysis of the 71 Borden type 3 shunts with exclusive leptomeningeal venous drainage, three patterns emerged. The commonest was the fistula engaging a bridging vein that had lost its connection to the parent sinus into which it previously drained; it was characterized by an arterial network of feeders converging onto the wall of a bridging vein, with leptomeningeal venous reflux. The other patterns were those of "isolated" sinus segment characterized by arterial feeders converging on to the wall of the dural sinus with leptomeningeal venous reflux following the opacification of the sinus and fistulae in the vicinity of the cribriform plate with two subtypes. The main angioarchitectural features of the 36 Borden type 2 shunts with mixed sinusal-cortical venous drainage were the presence of a diffuse arterial network of vessels converging onto a site in the wall of the dural sinus, with leptomeningeal venous reflux following the opacification of the sinus. In this group, four exceptions were noticed with arterial feeders converging onto a bridging vein and having a mixed venous drainage to the cortical venous system and the sinuses. We concluded that the exact location of the shunt with regard to the bridging veins is a key factor in the development of leptomeningeal venous drainage. Cranial dural arteriovenous fistulae (CDAVFs) of either Borden type 2 or 3 do not constitute a homogeneous group. The great majority of these shunts present thrombotic phenomena.
颅内硬脑膜动静脉瘘的软脑膜静脉引流是不良临床病程的最重要决定因素。文献中尚未充分探讨易引发其发生的因素。在本研究中，我们针对桥静脉，研究了分流位置与软脑膜静脉引流发展的关系。分析了19年间连续治疗的211例颅内硬脑膜动静脉瘘患者的血管造影数据。107例患者发现有软脑膜静脉引流的硬脑膜分流；其中，71例患者为单纯软脑膜静脉引流（Borden 3型）。记录了分流的血管构筑，包括动脉供血模式、与桥静脉的关系、主要静脉引流以及静脉流出受限情况。在分析了71例仅伴有软脑膜静脉引流的Borden 3型分流后，出现了三种模式。最常见的是瘘管与一条已失去与先前引流的母窦连接的桥静脉相连；其特征是供血动脉网络汇聚到桥静脉壁上，伴有软脑膜静脉反流。其他模式是“孤立”窦段模式，其特征是动脉供血汇聚到硬脑膜窦壁上，在窦和筛板附近的瘘管显影后伴有软脑膜静脉反流，有两个亚型。36例伴有窦 - 皮质混合静脉引流的Borden 2型分流的主要血管构筑特征是存在弥散的血管动脉网络汇聚到硬脑膜窦壁的一个部位，在窦显影后伴有软脑膜静脉反流。在该组中，注意到有4例例外情况，动脉供血汇聚到一条桥静脉，并向皮质静脉系统和窦有混合静脉引流。我们得出结论，分流相对于桥静脉的确切位置是软脑膜静脉引流发展的关键因素。Borden 2型或3型颅内硬脑膜动静脉瘘（CDAVF）并不构成一个同质群体。这些分流中的绝大多数会出现血栓形成现象。
