Satow Takeshi, Suzuki Megumu, Komuro Taro, Ogawa Masafumi, Kobayashi Akira, Nishida Sei
Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan.
Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan.
World Neurosurg. 2017 Jul;103:954.e5-954.e10. doi: 10.1016/j.wneu.2017.04.155. Epub 2017 May 3.
Cerebral pial arteriovenous fistula (AVF) is a rare disorder, and its natural course is uncertain. The present article reports 2 rare cases of pial AVF that underwent spontaneous cure after diagnostic cerebral angiogram.
A 73-year-old man presented with generalized seizure and reported severe but intermittent headache in the right temporo-occipital area. Single-photon emission computed tomography (SPECT) showed hyperperfusion in that area. The main finding of a cerebral angiogram was an arteriovenous shunt at the cortical surface of the right temporal area. Soon after this diagnostic angiogram, the symptoms vanished. A further cerebral angiogram showed the disappearance of this pial AVF, and a SPECT study showed resolution of the hyperperfusion of the affected area. A 69-year-old man, with a history of intracerebral hemorrhage on the left parietal area 3 years earlier, presented with speech disturbance and headache on his left side. SPECT showed hyperperfusion in the left temporoparietal area. A cerebral angiogram showed an arteriovenous shunt at the surface of the left parietal area. During the same cerebral angiogram session, the pial AVF disappeared after the third injection of a contrast medium with magnification. Two days after the cerebral angiogram, the patient's headache disappeared and speech disturbance gradually improved. SPECT also showed disappearance of the hyperperfusion.
It is possible that pial AVF is a cause of headache and neurologic symptoms in association with focal hyperperfusion. Diagnostic cerebral angiography should be performed to make a definite diagnosis; after this, pial AVF sometimes disappears.
大脑软膜动静脉瘘（AVF）是一种罕见疾病，其自然病程尚不确定。本文报道2例罕见的软膜AVF病例，其在诊断性脑血管造影后自发治愈。
一名73岁男性出现全身性癫痫发作，并自述右颞枕部严重但间歇性头痛。单光子发射计算机断层扫描（SPECT）显示该区域血流灌注增加。脑血管造影的主要发现是右侧颞叶皮质表面存在动静脉分流。在这次诊断性血管造影后不久，症状消失。进一步的脑血管造影显示该软膜AVF消失，SPECT研究显示受累区域血流灌注增加的情况得到缓解。一名69岁男性，3年前左侧顶叶有脑出血病史，出现言语障碍和左侧头痛。SPECT显示左侧颞顶叶血流灌注增加。脑血管造影显示左侧顶叶表面存在动静脉分流。在同一次脑血管造影过程中，在第三次注射造影剂并放大后，软膜AVF消失。脑血管造影后两天，患者头痛消失，言语障碍逐渐改善。SPECT也显示血流灌注增加的情况消失。
软膜AVF可能是与局灶性血流灌注增加相关的头痛和神经症状的一个原因。应进行诊断性脑血管造影以明确诊断；在此之后，软膜AVF有时会消失。
