Gross Bradley A, Ducruet Andrew F, Jankowitz Brian T, Gardner Paul A
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
World Neurosurg. 2017 Sep;105:1043.e7-1043.e9. doi: 10.1016/j.wneu.2017.07.015. Epub 2017 Jul 12.
Dural arteriovenous fistulas (dAVFs) often are treated via transarterial or transvenous embolization. Incomplete penetration of the draining vein/occult residual often will become apparent on follow-up angiography, requiring repeat embolization, or at times, surgical resection.
A 41-year-old woman presented with cerebellar hemorrhage from a tentorial dAVF treated with transvenous coil embolization. Follow-up angiography disclosed a residual/recurrent fistula treated with transvenous Onyx embolization. After further follow-up angiography demonstrated another occult residual/recurrence, the fistula was disconnected with the tentorial dura excised via a retrosigmoid approach. Six-month follow-up angiography demonstrated no recurrence.
Although endovascular treatment of dAVFs is generally first-line therapy, surgical disconnection of fistulas, particularly high-risk residual/recurrent fistulas, is an excellent option in well-selected cases.
硬脑膜动静脉瘘（dAVF）通常通过经动脉或经静脉栓塞治疗。引流静脉穿透不完全/隐匿性残留常在随访血管造影时显现，需要重复栓塞，有时还需手术切除。
一名41岁女性因小脑幕dAVF经静脉弹簧圈栓塞治疗后出现小脑出血。随访血管造影显示残留/复发性瘘，采用经静脉Onyx栓塞治疗。进一步随访血管造影显示又有隐匿性残留/复发后，通过乙状窦后入路切除小脑幕硬脑膜并切断瘘管。6个月的随访血管造影显示无复发。
尽管dAVF的血管内治疗通常是一线治疗，但对于精心挑选的病例，手术切断瘘管，尤其是高风险的残留/复发性瘘管，是一个很好的选择。
