Mondel Prabath Kumar, Saraf Rashmi, Limaye Uday S
Department of Interventional Neuroradiology, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India.
BMJ Case Rep. 2017 Feb 16;2017:bcr2016012939. doi: 10.1136/bcr-2016-012939.
A rete mirabile is a vascular network of intercommunicating small arteries or arterioles that replace the definitive adult artery supplying the brain. It supplies the brain in lower mammals but is not seen in normal human embryological development. A 26-year-old man presented with worsening tinnitus that was interfering with his sleep. On CT and digital subtraction angiography he was found to have a temporal lobe pial arteriovenous fistula with bilateral carotid and vertebral rete mirabile. The patient was offered open surgical and endovascular treatment options for pial arteriovenous fistula but he refused both and opted for conservative medical management. At 6-month follow-up he continued to have pulsatile tinnitus but was otherwise neurologically normal. We present the first described association of rete mirabile with pial arteriovenous fistula and discuss its clinical presentation and imaging features, with a review of the literature for bilateral carotid and vertebral rete mirabile.
奇网是由相互连通的小动脉或微动脉组成的血管网络，它替代了为大脑供血的成体终末动脉。在低等哺乳动物中，奇网为大脑供血，但在正常人类胚胎发育过程中未见奇网。一名26岁男性因耳鸣加重前来就诊，耳鸣影响了他的睡眠。经CT和数字减影血管造影检查，发现他患有颞叶软膜动静脉瘘，并伴有双侧颈动脉和椎动脉奇网。该患者可选择针对软膜动静脉瘘的开放手术和血管内治疗方案，但他均拒绝，并选择了保守药物治疗。在6个月的随访中，他仍有搏动性耳鸣，但在其他方面神经功能正常。我们首次描述了奇网与软膜动静脉瘘的关联，并讨论了其临床表现和影像学特征，同时回顾了有关双侧颈动脉和椎动脉奇网的文献。
