Department of Neurosurgery, North Shore University Hospital, Long Island, New York, USA.
Department of Neurosurgery, North Shore University Hospital, Long Island, New York, USA.
World Neurosurg. 2019 Jul;127:485. doi: 10.1016/j.wneu.2019.04.127. Epub 2019 Apr 23.
Posterior fossa dural arteriovenous fistulas are rare vascular malformations. If associated with cortical venous reflux, they present a significant risk of hemorrhage. We present a 54-year-old male who presented with progressive hearing loss without other neurologic symptoms. Further workup revealed tentorial incisura dural arteriovenous fistula with cortical venous reflux and aneurysmal dilation of venous drainage (type IV Cognard), fed from the right internal carotid artery and external carotid artery. After multidisciplinary discussion, we decided on surgical disconnection of the fistula as we felt this approach would have the highest chance of immediate and durable cure. We performed a right retrosigmoid craniotomy with (Video 1) disconnection of the arterialized veins and thus achieved completed obliteration. Follow-up angiography 8 months later showed no evidence of residual/recurrent fistula. The patient's hearing improved. There were no adverse effects during the perioperative period.
天幕裂孔区硬脑膜动静脉瘘较为罕见，若合并皮质静脉回流，其出血风险较大。我们报告了一例 54 岁男性患者，表现为进行性听力下降，无其他神经系统症状。进一步检查显示天幕切迹硬脑膜动静脉瘘，伴有皮质静脉回流和静脉引流的动脉瘤样扩张（Cognard Ⅳ 型），由右侧颈内动脉和颈外动脉供血。经过多学科讨论，我们决定采用手术方法断开瘘口，因为我们认为这种方法最有可能立即和持久治愈。我们进行了右侧乙状窦后颅切开术（视频 1），断开了动脉化静脉，从而实现了完全闭塞。8 个月后的随访血管造影显示无残留/复发瘘。患者听力改善，围手术期无不良反应。
