Yoshioka Shotaro, Kuwayama Kazuyuki, Satomi Junichiro, Nagahiro Shinji
Department of Neurosurgery, The University of Tokushima Graduate School, Tokushima, Japan.
Neurosurgery. 2015 Sep;11 Suppl 3:E468-71. doi: 10.1227/NEU.0000000000000773.
Intraosseous dural arteriovenous fistulae (DAVF) are rare, especially those with drainage into the diploic venous system. The clinical presentation depends on the location of the lesion. This is the first report of an intraosseous DAVF associated with acute epidural hematoma.
A 25-year-old man presented with headache and nausea. Imaging of the brain revealed abnormal signals indicative of acute epidural hematoma in the right frontal convexity. Angiography demonstrated a DAVF in the region of the frontal bone. Right external carotid artery angiography showed that the DAVF was fed mainly by the right middle meningeal artery with drainage into diploic veins. Immediately after embolization of the middle meningeal and the distal internal maxillary artery with 17% N-butyl-2-cyanoacrylate, the shunt was completely occluded. The patient was discharged 4 days later without clinical complications.
Intraosseous DAVF can be treated by surgical resection or endovascular embolization. Curative treatment requires careful inspection of the angiographic architecture and microsurgical anatomy.
骨内硬脑膜动静脉瘘（DAVF）较为罕见，尤其是那些引流至板障静脉系统的瘘。临床表现取决于病变的位置。这是首例与急性硬膜外血肿相关的骨内DAVF报告。
一名25岁男性出现头痛和恶心。脑部影像学检查显示右额凸面有提示急性硬膜外血肿的异常信号。血管造影显示额骨区域有一个DAVF。右颈外动脉血管造影显示，该DAVF主要由右脑膜中动脉供血，引流至板障静脉。在用17%的N-丁基-2-氰基丙烯酸酯栓塞脑膜中动脉和上颌内动脉远端后，分流立即完全闭塞。患者4天后出院，无临床并发症。
骨内DAVF可通过手术切除或血管内栓塞治疗。根治性治疗需要仔细检查血管造影结构和显微手术解剖结构。
