Halbach V V, Higashida R T, Hieshima G B, Rosenblum M, Cahan L
Department of Radiology, University of California, San Francisco 94143.
AJNR Am J Neuroradiol. 1988 Mar-Apr;9(2):337-43.
We report the diagnosis and treatment of seven dural arteriovenous malformations involving the superior sagittal sinus. The most common presenting symptom was headache, although two patients presented with hemorrhage. Embolization alone effected a complete cure in four patients, while a combination of embolization and surgery was used in the remaining three patients. The first of these had intraoperative exposure and embolization of multiple feeding branches of both middle meningeal arteries, which resulted in a complete cure without deficits. The second patient had multiple embolizations and surgeries with eventual resection of the involved sagittal sinus to effect a complete cure, which was complicated postoperatively by paraparesis. The third patient had preoperative embolization and subsequent surgical resection of the superior sagittal sinus, resulting in a complete cure without deficits. Because of their unique midline location, multiplicity of arterial feeders, and critical venous drainage, dural malformations involving the superior sagittal sinus often require unusual and aggressive forms of therapy.
我们报告了7例累及上矢状窦的硬脑膜动静脉畸形的诊断和治疗情况。最常见的首发症状是头痛,不过有2例患者表现为出血。单纯栓塞治疗使4例患者完全治愈,其余3例患者则采用了栓塞与手术相结合的治疗方法。其中第一例患者在术中暴露并栓塞了双侧脑膜中动脉的多个供血分支,从而实现了完全治愈且无功能缺损。第二例患者接受了多次栓塞和手术,最终切除了受累的矢状窦以实现完全治愈,但术后出现了双下肢轻瘫的并发症。第三例患者在术前进行了栓塞,随后切除了上矢状窦,实现了完全治愈且无功能缺损。由于其独特的中线位置、动脉供血支的多样性以及关键的静脉引流,累及上矢状窦的硬脑膜畸形通常需要采用特殊且积极的治疗方式。