Li Jingwei, Gao Zeng, Zhi Xinglong, Du Jianxin, Zhang Hongqi, Ling Feng
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2018 Sep;117:292-297. doi: 10.1016/j.wneu.2018.05.110. Epub 2018 May 24.
Intracranial pial arteriovenous fistulas (PAVFs) are rare cerebrovascular lesions with high mortality rates. We report a rare case of pediatric PAVF at the basilar artery tip and its treatment with surgical clipping aided by a trapping-evacuation technique in a hybrid operating room.
An 18-month-old boy was admitted with hypoevolutism and 4-month history of weakness in the left extremities. Magnetic resonance imaging showed a giant aneurysm-like malformation in the area of midbrain and pons. Angiography showed a high-flow PAVF fed by the basilar artery and bilateral P1 segments of the posterior cerebral artery, with deep draining veins into the transverse sinus and straight sinus. Given the intrinsic characteristics of the lesion, such as deep location, giant fistula and varix, and multiple feeding arteries, clipping of PAVF was performed in a hybrid operating room aided by a trapping-evacuation technique to clearly identify and block the shunting point.
The successful obliteration of the lesion is reported. In addition, a brief review of literature comparing endovascular embolization, surgical disconnection, and hybrid technique for treatment of PAVF is included.
颅内软膜动静脉瘘（PAVF）是一种罕见的脑血管病变，死亡率很高。我们报告了一例罕见的小儿基底动脉尖PAVF病例，以及在杂交手术室采用圈套-抽吸引流技术辅助手术夹闭的治疗方法。
一名18个月大的男孩因发育迟缓及左下肢无力4个月病史入院。磁共振成像显示中脑和脑桥区域有一个巨大的动脉瘤样畸形。血管造影显示为高流量PAVF，由基底动脉和双侧大脑后动脉P1段供血，深部引流静脉汇入横窦和直窦。鉴于病变的固有特征，如位置深、瘘口巨大、静脉瘤样扩张以及多条供血动脉，在杂交手术室采用圈套-抽吸引流技术辅助进行PAVF夹闭，以清晰识别并阻断分流点。
报告了病变的成功闭塞情况。此外，还对比较血管内栓塞、手术切断和杂交技术治疗PAVF的文献进行了简要综述。
