Bernard Florian, Lemée Jean-Michel, Faguer Rogatien, Fournier Henri-Dominique
Department of Neurosurgery, Teaching Hospital, Angers, France.
Department of Neurosurgery, Teaching Hospital, Angers, France.
World Neurosurg. 2018 May;113:312-315. doi: 10.1016/j.wneu.2018.02.161. Epub 2018 Mar 7.
The radiological signs of intracranial dural arteriovenous fistulas (ICDAVFs) are heterogenous. While it is commonly accepted that hyper intense T2 wedge magnetic resonance imaging of the brainstem and cervical cord mainly concern gliomas, it is so far uncommon and probably unknown that ICDAVFs can imitate similar radiological pattern, especially with gadolinium contrast enhancement and cord enlargement. Thus the angiography is poorly documented in the diagnostic workup. We report the unusual history of ICDAVFs, revealed by clinical and radiological features that mimicked a medulla or cervical spinal cord glioma. This observation provides information on the management of atypical lesions mimicking medulla or cervical cord glioma and arguments for a careful radiological study. Looking for dilated veins around the brainstem and the cord is mandatory in the workup of a supposed infiltrating brainstem or spinal cord lesion, in order to rule out an ICDAVF. Even if the hyperintense T2 images associated with contrast enhancement is in favor of a brainstem or spinal cord glioma, additional cerebral angiography should be mandatory. Moreover, this clinical case highlights the need for a multidisciplinary approach including neuroradiologist, oncologist and neurosurgeon.
颅内硬脑膜动静脉瘘（ICDAVF）的放射学表现具有异质性。虽然人们普遍认为，脑干和颈髓的T2加权像高信号主要与胶质瘤有关，但迄今为止，ICDAVF能模仿类似的放射学表现，尤其是钆增强和脊髓增粗，这种情况并不常见，可能也不为人所知。因此，在诊断检查中，血管造影的记录很少。我们报告了ICDAVF的不寻常病例，其临床和放射学特征类似于延髓或颈髓胶质瘤。该病例为疑似延髓或颈髓胶质瘤的非典型病变的处理提供了信息，并为进行仔细的放射学研究提供了依据。在疑似脑干或脊髓浸润性病变的检查中，必须寻找脑干和脊髓周围扩张的静脉，以排除ICDAVF。即使与增强相关的T2加权像高信号支持脑干或脊髓胶质瘤的诊断，也应进行额外的脑血管造影。此外，该临床病例强调了多学科方法的必要性，包括神经放射科医生、肿瘤学家和神经外科医生。
