海绵窦硬脑膜动静脉瘘伴脑干增强病变，类似于恶性肿瘤。
Cavernous Sinus Dural Arteriovenous Fistula with an Enhanced Lesion in the Brainstem Mimicking a Malignant Tumor.
机构信息
Division of Neuroscience, Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Japan.
Division of Neuroscience, Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Japan.
出版信息
World Neurosurg. 2020 Aug;140:13-17. doi: 10.1016/j.wneu.2020.04.165. Epub 2020 May 11.
BACKGROUND
Cavernous sinus (CS) dural arteriovenous fistula (dAVF) with an enhanced lesion in the brainstem is rare, and an enhanced lesion in the brainstem might be indicative of irreversibility.
CASE DESCRIPTION
A 77-year-old woman presented with double vision and ataxia. Magnetic resonance imaging showed a unilateral enhancement lesion in the pons, so a malignant brain tumor was suspected. A cerebral angiogram revealed CS-dAVF with retrograde leptomeningeal venous drainage (RLVD) to the brainstem. Transvenous embolization with selective coil embolization of RLVD was performed, and the symptoms and imaging improved dramatically.
CONCLUSIONS
DAVFs with RLVD should be mentioned as a differential diagnosis of enhanced lesions in the brainstem. Transvenous embolization with selective coil embolization of RLVD was effective for the treatment of CS-dAVF, and a unilateral enhanced brainstem lesion may be reversible.
背景
海绵窦（CS）硬脑膜动静脉瘘（dAVF）伴脑干强化病变较为罕见，而脑干强化病变可能提示不可逆转。
病例描述
一名 77 岁女性因复视和共济失调就诊。磁共振成像显示单侧脑桥强化病变，故疑诊恶性脑肿瘤。脑血管造影显示 CS-dAVF 伴逆行软脑膜静脉引流（RLVD）至脑干。行经静脉栓塞治疗，选择性线圈栓塞 RLVD，症状和影像学明显改善。
结论
伴有 RLVD 的 DAVF 应作为脑干强化病变的鉴别诊断。经静脉栓塞治疗，选择性线圈栓塞 RLVD 对 CS-dAVF 治疗有效，单侧脑干强化病变可能是可逆的。
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