Tanaka Michihiro
Department of Neurosurgery, Kameda Medical Center, Higashi-cho 929, Kamogawa City, Chiba, 296-8602, Japan.
Acta Neurochir Suppl. 2016;123:169-76. doi: 10.1007/978-3-319-29887-0_24.
The distribution of intracranial dural AVFs (DAVFs) may be affected by the embryological bony structures that consist of membranous bone and endochondral bone.
We retrospectively analyzed the distribution of the shunt points in 58 consecutive cases of DAVFs. Shunt points were identified with selective digital subtraction angiography, high-resolution cone beam computed tomography (CT), or three-dimensional rotation angiography. All the shunt points were plotted on the map of the skull base in relation to the topography of the endochondral bone and the membranous bone. If the shunt point was localized on the surface of endochondral bone, this was categorized as the endochondral bone group. If it was located on membranous bone, this was categorized as the membranous bone group. If the shunt point was independent from both bony structures, this was categorized as the independent group.
In 55 of 58 cases, shunt points were identified angiographically. Three cases had multiple shunts. There were 33 shunt points (60 %) belonging to endochondral bone. In this group, 16 cases of sigmoid, 11 of carotid cavernous, 3 of petrosal apex, and 3 of sigmoid DAVF were observed. There were 12 shunt points (22 %) localized on membranous bone; in this group, there were nine cases of transverse sinus, two of superior sagittal sinus, and one case of confluence DAVF. There were ten shunt points (18 %) independent from these two bony structures: four cases of olfactory groove, four . of middle fossa, and two of hypoglossal canal DAVF.
There were correlations between the localization of shunt points of DAVFs and the topography of endochondral bone and the membranous bone. The histological difference of endochondral bone and membranous bone at the level of epidural space might cause the formation of DAVFs.
颅内硬脑膜动静脉瘘（DAVFs）的分布可能受由膜性骨和软骨内骨组成的胚胎学骨性结构影响。
我们回顾性分析了58例连续性DAVFs患者分流点的分布情况。通过选择性数字减影血管造影、高分辨率锥形束计算机断层扫描（CT）或三维旋转血管造影确定分流点。所有分流点均根据软骨内骨和膜性骨的地形绘制在颅底地图上。如果分流点位于软骨内骨表面，则归为软骨内骨组。如果位于膜性骨上，则归为膜性骨组。如果分流点独立于这两种骨性结构，则归为独立组。
58例患者中有55例通过血管造影确定了分流点。3例有多个分流。33个分流点（60%）属于软骨内骨。该组中观察到16例乙状窦、11例海绵窦、3例岩尖和3例乙状窦DAVFs。12个分流点（22%）位于膜性骨上；该组中有9例横窦、2例上矢状窦和1例窦汇DAVFs。有10个分流点（18%）独立于这两种骨性结构：4例嗅沟、4例中颅窝和2例舌下神经管DAVFs。
DAVFs分流点的定位与软骨内骨和膜性骨的地形之间存在相关性。硬膜外间隙水平的软骨内骨和膜性骨的组织学差异可能导致DAVFs的形成。
