Ohnishi Yuichiro, Takenaka Tomofumi, Fujiwara Sho
Department of Neurosurgery, Osaka Gyoumeikan Hospital, Osaka, Osaka, Japan.
Department of Neurosurgery, Osaka University Medical School, Suita, Osaka, Japan.
NMC Case Rep J. 2022 Jun 21;9:193-198. doi: 10.2176/jns-nmc.2022-0014. eCollection 2022.
Tentorial dural arteriovenous fistula (DAVF) is an aggressive vascular lesion causing progressive neurological deficits. Venous congestive cervical edema is a rare phenomenon caused by tentorial DAVF. Obliteration of the fistula and venous drainage should be the goal of treatment. A 62-year-old man was admitted with lower limb weakness and numbness. Magnetic resonance imaging (MRI) revealed extensive edema of the upper cervical cord with signal flow void at the anterior spinal cord. Internal carotid angiography revealed a tentorial arteriovenous shunt near the superior petrosal sinus fed mainly by the tentorial artery. The petrosal vein was dilated, with the transverse pontine vein, medial medullary vein, and anterior spinal vein as the main drainage route. This suggests that venous hypertension triggered the upper cervical cord edema. MRI with gadolinium enhancement showed that the varix was located just distal to the shunt. Microsurgical obliteration of the fistula and venous drainage were achieved via a suboccipital approach. A postoperative evaluation showed the disappearance of the cervical cord edema with improved clinical symptoms. Tentorial DAVF with spinal venous drainage presents with mild and slow progression of symptoms. Differential diagnosis and definite treatment are mandatory to avoid a delayed diagnosis and irreversible symptoms.
小脑幕硬脑膜动静脉瘘（DAVF）是一种侵袭性血管病变，可导致进行性神经功能缺损。静脉充血性颈髓水肿是小脑幕DAVF引起的一种罕见现象。闭塞瘘口和静脉引流应是治疗的目标。一名62岁男性因下肢无力和麻木入院。磁共振成像（MRI）显示颈髓上段广泛水肿，脊髓前部有血流空信号。颈内动脉血管造影显示岩上窦附近有一个小脑幕动静脉分流，主要由小脑幕动脉供血。岩静脉扩张，以脑桥横静脉、延髓内侧静脉和脊髓前静脉为主要引流途径。这表明静脉高压引发了颈髓上段水肿。钆增强MRI显示静脉曲张位于分流的远侧。通过枕下入路实现了瘘口和静脉引流的显微闭塞。术后评估显示颈髓水肿消失，临床症状改善。伴有脊髓静脉引流的小脑幕DAVF症状进展轻微且缓慢。必须进行鉴别诊断和明确治疗，以避免延迟诊断和不可逆症状。
