Tokunaga T, Hayashi T, Shojima K, Utsunomiya H, Matsuo M
No Shinkei Geka. 1986 Oct;14(11):1391-5.
Idiopathic dural arteriovenous malformation which occurs in the posterior fossa uses predominantly transverse and sigmoid sinuses. Cavernous sinus comes next and others are rather rare. However, we have recently experienced such a rare case which was operated on and cured completely. The malformation was fed through the anterior ethmoid artery and drained to the cortical vein. The case was a 36-year-old male and admitted in our clinic for having headache and nausea as the chief complaints. He was diagnosed subarachnoid hemorrhage due to the following findings: CT scans showed a high density zone localized in the sylvian vallecula. Cerebrospinal fluid obtained by a lumbar puncture was found to be bloody. No neurological abnormality other than neck stiffness and positive Kernig's sign was observed. Under study of right carotid arteriography, dural AVM was evident. The anterior ethmoidal artery which branched out from the ophthalmic artery fed the AVM. The cortical vein which ran on the surface of the frontal base was its drainer via a small nidus. There was no abnormality seen on a left carotid arteriogram. Surgery was proceeded with the right frontal craniectomy in extra- and intradural approach. At first, anterior ethmoidal artery was cut at the cribriform plate extradurally. After dura was incised, both the nidus and drainer were coagulated intradurally. The nidus was located at inner surface of the dura. The arachnoid hemorrhage was thought to be caused by rupture of this drainer.(ABSTRACT TRUNCATED AT 250 WORDS)
发生于后颅窝的特发性硬脑膜动静脉畸形主要累及横窦和乙状窦。其次为海绵窦，其他部位则较为罕见。然而，我们最近遇到了这样一例罕见病例，并成功进行了手术且完全治愈。该畸形由筛前动脉供血，经皮质静脉引流。患者为36岁男性，因头痛和恶心为主诉入院。根据以下检查结果诊断为蛛网膜下腔出血：CT扫描显示外侧裂池内有高密度区。腰椎穿刺获取的脑脊液呈血性。除颈部僵硬和克氏征阳性外，未发现其他神经功能异常。在右侧颈动脉造影检查中，硬脑膜动静脉畸形清晰可见。从眼动脉分支出来的筛前动脉为该动静脉畸形供血。在额叶底部表面走行的皮质静脉通过一个小病灶作为其引流静脉。左侧颈动脉造影未见异常。采用右侧额部开颅术，经硬膜外和硬膜内入路进行手术。首先，在硬膜外于筛板处切断筛前动脉。切开硬脑膜后，在硬膜内对病灶和引流静脉进行凝固处理。病灶位于硬脑膜内表面。蛛网膜下腔出血被认为是由该引流静脉破裂所致。（摘要截选至250字）
