Lam Siu Kei Samuel, Chu Sai Lok, Yuen Shing Chau, Yam Kwong Yui
Department of Neurosurgery, Tuen Mun Hospital, Hong Kong Special Administrative Region, Tuen Mun, Hong Kong.
J Neurol Surg B Skull Base. 2021 Feb;82(Suppl 1):S45-S47. doi: 10.1055/s-0040-1714402. Epub 2020 Nov 26.
We report a case of craniocervical junction dural arteriovenous fistula (dAVF) presented with myelopathy and normal pressure hydrocephalus, and was treated with hybrid approach of embolization and surgical disconnection. A 68-year-old gentleman presented with 1 year history of unsteady gait and sphincter disturbance. Magnetic resonance imaging (MRI) showed abnormally enlarged and tortuous vessels over right cerebellomedullary cistern. Digital subtraction angiogram (DSA) showed Cognard's type-V dAVF at craniocervical junction. Catheter embolization was performed via external carotid artery and finally surgical disconnection was done with far lateral approach ( Fig. 1 ). Postoperative DSA showed no more arteriovenous shunting ( Fig. 2 ). Clinically the patient improved after a course of rehabilitation. Dural AVF at craniocervical junction is rare and its clinical presentation can be highly variable from subarachnoid hemorrhage to brainstem dysfunction. Identification of the exact fistula site is essential in surgical planning. Surgery is effective and safe to achieve complete obliteration and good clinical outcome. 1 2 3 4 5 6 The link to the video can be found at: https://youtu.be/xI48stSlWpY .
我们报告一例颅颈交界区硬脑膜动静脉瘘（dAVF），表现为脊髓病和正常压力脑积水，并采用栓塞和手术切断的联合方法进行治疗。一名68岁男性，有1年步态不稳和括约肌功能障碍病史。磁共振成像（MRI）显示右侧小脑延髓池有异常增粗和迂曲的血管。数字减影血管造影（DSA）显示颅颈交界区为Cognard V型dAVF。通过颈外动脉进行导管栓塞，最后采用远外侧入路进行手术切断（图1）。术后DSA显示不再有动静脉分流（图2）。经过一个疗程的康复治疗，患者临床症状改善。颅颈交界区硬脑膜动静脉瘘罕见，其临床表现从蛛网膜下腔出血到脑干功能障碍差异很大。准确识别瘘口部位对手术规划至关重要。手术有效且安全，可实现完全闭塞并取得良好的临床效果。1 2 3 4 5 6 视频链接可在：https://youtu.be/xI48stSlWpY 找到。
