Kim Dong Jin, Park Wonhyoung, Park Jung Cheol, Ahn Jae Sung, Lee Deok Hee, Byun Joonho
Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
J Cerebrovasc Endovasc Neurosurg. 2021 Mar;23(1):41-48. doi: 10.7461/jcen.2020.E2020.08.001. Epub 2020 Oct 6.
We report a case of lateral cavernous sinus wall dural arteriovenous fistula (DAVF) accompanied large venous aneurysm which is presented intracerebral hemorrhage (ICH). A 58-year-old male patient came to emergency department for acute onset of headache and dysarthria. In brain computed tomography scan, large left temporal lobe ICH was noted. In transfemoral cerebral angiography, multiple arteries from external carotid artery and left internal carotid artery (ICA) fed arteriovenous shunt. This shunt was drained through cavernous sinus with enlarged multiple cortical veins. One large venous aneurysm was estimated as bleeding focus for ICH. Considering ICH and high flow shunt, we planned urgent treatment to reduce flow of arteriovenous shunt. However, transvenous embolization was failed due to tortuous venous anatomy. Therefore, we planned craniotomy and microsurgical treatment. There was engorged small vessel in lateral wall of cavernous sinus and vascular trunk which is fistulous connection was noted. Fistula connection was obliterated and disconnected after coagulation. In postoperative image, fistula was completely disappeared and there was no cortical venous reflux, also large venous aneurysm was disappeared. Patient recovered very well without new neurological deficits. We reported successfully treated lateral cavernous sinus wall DAVF by combined endovascular and transcranial-microsurgical treatment.
我们报告一例伴有大型静脉瘤的海绵窦外侧壁硬脑膜动静脉瘘（DAVF），该患者出现了脑出血（ICH）。一名58岁男性患者因突发头痛和构音障碍来到急诊科。脑部计算机断层扫描显示左侧颞叶有大量脑出血。经股动脉脑血管造影显示，来自颈外动脉和左侧颈内动脉（ICA）的多条动脉为动静脉分流供血。该分流通过海绵窦引流，多条皮质静脉增粗。一个大型静脉瘤被认为是脑出血的出血灶。考虑到脑出血和高流量分流，我们计划进行紧急治疗以减少动静脉分流的血流量。然而，由于静脉解剖结构迂曲，经静脉栓塞失败。因此，我们计划进行开颅显微手术治疗。在海绵窦外侧壁发现有充血的小血管和可见瘘管连接的血管主干。在凝固后，瘘管连接被闭塞并切断。术后影像显示，瘘管完全消失，没有皮质静脉回流，大型静脉瘤也消失了。患者恢复良好，没有出现新的神经功能缺损。我们报告了通过血管内和经颅显微手术联合治疗成功治愈海绵窦外侧壁DAVF的病例。
