Tanaka Michihiro
Department of Neurosurgery, Kameda Medical Center, Kamogawa, Japan.
Neurointervention. 2019 Mar;14(1):9-16. doi: 10.5469/neuroint.2018.01095. Epub 2019 Feb 28.
Intracranial and spinal dural arteriovenous fistulas (DAVFs) are vascular pathologies of the dural membrane with arteriovenous shunts. They are abnormal communications between arteries and veins or dural venous sinuses that sit between the two sheets of the dura mater. The dura propria faces the surface of brain, and the osteal dura faces the bone. The location of the shunt points is not distributed homogeneously on the surface of the dural membrane, but there are certain areas susceptible to DAVFs. The dura mater of the olfactory groove, falx cerebri, inferior sagittal sinus, tentorium cerebelli, and falx cerebelli, and the dura mater at the level of the spinal cord are composed only of dura propria, and these areas are derived from neural crest cells. The dura mater of the cavernous sinus, transverse sinus, sigmoid sinus, and anterior condylar confluence surrounding the hypoglossal canal are composed of both dura propria and osteal dura; this group is derived from mesoderm. Although the cause of this heterogeneity has not yet been determined, there are some specific characteristics and tendencies in terms of the embryological features. The possible reasons for the segmental susceptibility to DAVFs are summarized based on the embryology of the dura mater.
颅内和脊髓硬脑膜动静脉瘘（DAVFs）是伴有动静脉分流的硬脑膜血管病变。它们是位于硬脑膜两层之间的动脉与静脉或硬脑膜静脉窦之间的异常交通。硬脑膜固有层面向脑表面，骨膜层面向颅骨。分流点在硬脑膜表面的分布并不均匀，但存在某些易发生DAVFs的区域。嗅沟、大脑镰、下矢状窦、小脑幕和小脑镰的硬脑膜，以及脊髓水平的硬脑膜仅由硬脑膜固有层组成，这些区域起源于神经嵴细胞。海绵窦、横窦、乙状窦以及围绕舌下神经管的前髁汇合处的硬脑膜由硬脑膜固有层和骨膜层组成；这一组起源于中胚层。虽然这种异质性的原因尚未确定，但在胚胎学特征方面存在一些特定的特点和倾向。基于硬脑膜的胚胎学总结了DAVFs节段易感性的可能原因。
