Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705.
Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan.
Acta Neurochir (Wien). 2023 Jun;165(6):1557-1564. doi: 10.1007/s00701-023-05585-8. Epub 2023 Apr 22.
Dural arteriovenous fistulas (DAVFs) are a group of diseases involving problematic shunts between dural arteries and venous structures such as sinuses, meningeal veins, or even cortical veins. To focus on craniocervical junction dural arteriovenous fistulas (DAVFs), we introduce a minimally invasive technique with midline incision combined with intraoperative digital subtraction angiography (DSA). This hybrid technique can minimize the incision wound to an average of 6 cm which leads to less destruction and lower risk of adverse events.
Using this minimally invasive approach, surgical obliteration was achieved in 6 patients with craniocervical junction DAVFs. A minimal midline incision was made over the C1-2 level, measuring approximately 5 to 7 cm in length. C1 hemilaminectomy was performed for DAVF obliteration followed by intraoperative DSA for confirmation of complete obliteration.
Among these 6 patients, the radiculomedullary artery was the most common feeding artery. The mean length of the operation (including DSA performance) was 6.5 ± 1.4 h. None of these cases showed cerebrospinal fluid leakage or exacerbation of neurological symptoms after the operation.
Using intraoperative DSA, the minimally invasive technique offers more precise but less destructive access than conventional far lateral suboccipital craniotomy. Most importantly, intraoperative DSA provided verification of complete closure for shunts that could not be examined for indocyanine green (ICG) dye because the microscope did not have a clear line of sight. In our experience, this technique shows encouraging results of fistula obliteration.
硬脑膜动静脉瘘（DAVFs）是一组涉及硬脑膜动脉与静脉结构（如窦、脑膜静脉甚至皮质静脉）之间存在问题分流的疾病。为了关注颅颈交界区硬脑膜动静脉瘘（DAVFs），我们引入了一种微创技术，采用中线切口结合术中数字减影血管造影（DSA）。这种混合技术可以将切口伤口最小化至平均 6 厘米，从而减少破坏和不良事件的风险。
使用这种微创方法，我们成功治疗了 6 例颅颈交界区 DAVFs 患者。在 C1-2 水平做一个最小的中线切口，长度约为 5 到 7 厘米。为了闭塞 DAVF，我们进行了 C1 半椎板切除术，然后在术中进行 DSA 以确认完全闭塞。
在这 6 例患者中，最常见的供血动脉是根髓动脉。手术（包括 DSA 操作）的平均长度为 6.5 ± 1.4 小时。这些病例均未出现脑脊液漏或术后神经症状恶化。
与传统的远外侧枕下入路开颅术相比，术中 DSA 的微创技术提供了更精确但破坏性更小的入路。最重要的是，术中 DSA 为显微镜无法清楚观察到的情况下不能用吲哚菁绿（ICG）染料检查的分流提供了完全闭合的验证。根据我们的经验，这种技术显示出令人鼓舞的瘘管闭塞效果。
