Choi Su Yong, Yoo Chan Jong, Kim Jin Yook, Kim Myeong Jin
Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea.
J Cerebrovasc Endovasc Neurosurg. 2015 Sep;17(3):263-7. doi: 10.7461/jcen.2015.17.3.263. Epub 2015 Sep 30.
The approach to ethmoidal dural arteriovenous fistulas (eDAVFs) is usually via a pterional or a frontal craniotomy. However, the transfrontal sinus is a more direct route to the fistula. The aim of this report is to describe our experience and associated complications occurring as a result of flow diversion in the transfrontal sinus approach for eDAVFs. In this report, we discuss visual field defects occurring after a transfrontal sinus operation. This approach is most direct for surgical treatment of an eDAVF, enabling preservation of neural structures with minimal to no negative effects on the brain. Although the surgery was uneventful, the patient presented with a left side visual field defect. An ophthalmologic exam detected an arterial filling delay in the choroidal membrane and ischemic optic neuropathy was highly suspected. The patient is currently recovering under close observation with no special treatment. The transfrontal sinus approach provides the most direct and shortest route for eDAVFs, while minimizing intraoperative bleeding. However, complications, such as visual field defects may result from a sudden flow diversion or eyeball compression due to scalp traction.
筛窦硬脑膜动静脉瘘（eDAVFs）的治疗方法通常是经翼点或额部开颅手术。然而，经额窦是到达瘘口的更直接途径。本报告的目的是描述我们在经额窦入路治疗eDAVFs时进行血流改道的经验及相关并发症。在本报告中，我们讨论了经额窦手术后出现的视野缺损。这种方法对于eDAVF的手术治疗最为直接，能够在对大脑产生最小或无负面影响的情况下保留神经结构。尽管手术过程顺利，但患者出现了左侧视野缺损。眼科检查发现脉络膜动脉充盈延迟，高度怀疑为缺血性视神经病变。患者目前正在密切观察下恢复，未进行特殊治疗。经额窦入路为eDAVFs提供了最直接和最短的路径，同时将术中出血降至最低。然而，视野缺损等并发症可能是由于突然的血流改道或头皮牵引导致眼球受压引起的。
