Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA; Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
World Neurosurg. 2020 Oct;142:404-407. doi: 10.1016/j.wneu.2020.07.062. Epub 2020 Jul 17.
Superficial temporal artery (STA)-to-middle cerebral artery bypass is frequently performed for moyamoya disease. We discuss an unusual case in a moyamoya patient complicated by the development of dural and pial arteriovenous fistulae (AVF). Both AVF then spontaneously resolved 2 years after surgery.
A patient in the fifth decade of life presented after multiple strokes resulting in right-sided weakness and numbness. Magnetic resonance imaging revealed remote strokes, and angiography revealed Suzuki grade 3 moyamoya angiopathy bilaterally. With a diminutive left STA, we initially performed left-sided dual-vessel pial synangioses. After radiographic evidence of robust revascularization and improved hemispheric perfusion, a combined right STA-middle cerebral artery bypass was done. However, routine 8-month postoperative angiography identified dural and pial AVF within the prior operative field. On the 2-year surveillance cerebral angiogram, both AVF were no longer present.
AVF as a complication of revascularization surgery is rare. Here, we discuss the possible pathophysiologic mechanisms that we theorize may have contributed and current treatment options and indications. We also review the literature surrounding this phenomenon.
颞浅动脉（STA）-大脑中动脉搭桥术常用于治疗烟雾病。我们讨论了一例烟雾病患者并发硬脑膜和软脑膜动静脉瘘（AVF）的不寻常病例。这两个瘘在手术后 2 年内自发消退。
一位 50 多岁的患者因多次中风导致右侧无力和麻木而就诊。磁共振成像显示陈旧性中风，血管造影显示双侧 Suzuki 3 级烟雾病。由于左侧 STA 细小，我们最初进行了左侧双血管软膜吻合术。在有充分的血运重建和半球灌注改善的影像学证据后，进行了右侧 STA-大脑中动脉搭桥术。然而，常规的 8 个月术后血管造影显示先前手术区域内存在硬脑膜和软脑膜动静脉瘘。在 2 年的随访脑血管造影中，两个瘘都不再存在。
AVF 是血运重建手术的罕见并发症。在这里，我们讨论了可能导致这种情况的病理生理机制，并讨论了当前的治疗选择和适应证。我们还回顾了围绕这一现象的文献。
