Yee Phyo Wint Shwe, Kotaro Tatebayashi, Kazutaka Uchida, Shinichi Yoshimura
Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
J Cerebrovasc Endovasc Neurosurg. 2024 Dec;26(4):405-411. doi: 10.7461/jcen.2024.E2024.05.001. Epub 2024 Aug 5.
Convexity dural arteriovenous fistula (dAVF) is associated with high-grade dAVF and is usually presented with aggressive clinical presentation. Precise diagnosis and understanding the pathogenesis are important to achieving successful treatment without complications. We report a case of dAVF with Sylvian-Labbé collateral pattern, concerning embryological development that was thought to be involved in the vascular architecture and pathogenesis of dural AVF. Thus, a 60-year-old man was presented with sudden onset of seizure with no history of trauma. Magnetic Resonance Imaging (MRI) showed cortical hemorrhage in the left precentral gyrus. Digital subtraction angiography (DSA) showed the convexity dural arteriovenous fistula (dAVF) involving a vein that appeared to be the vein of Labbé, the drainer was anastomosed with superior middle cerebral vein (SMCV) and formed the varix. With the successful treatment with trans-arterial embolization (TAE), obliteration of dAVF was achieved with no neurological deficits. This case highlights convexity dAVF with the complex relationship between embryological development and the arcade of venous drainage route, wherein the anomaly might be acquired and caused by elevated venous pressure in a vein that appeared to be the vein of Labbé. Gaining knowledge of the embryological basis may aid in a deeper understanding of acquired pathologies.
凸面硬脑膜动静脉瘘（dAVF）与高级别dAVF相关，通常表现为侵袭性临床表现。准确诊断并了解其发病机制对于实现无并发症的成功治疗至关重要。我们报告一例具有大脑外侧裂-拉贝静脉侧支模式的dAVF病例，该病例涉及胚胎发育，而胚胎发育被认为与硬脑膜动静脉瘘的血管结构和发病机制有关。因此，一名60岁男性，无外伤史，突然发作癫痫。磁共振成像（MRI）显示左侧中央前回皮质出血。数字减影血管造影（DSA）显示凸面硬脑膜动静脉瘘（dAVF）累及一条似乎是拉贝静脉的静脉，引流静脉与大脑中浅静脉（SMCV）吻合并形成静脉曲张。经动脉栓塞（TAE）成功治疗后，dAVF闭塞，无神经功能缺损。该病例突出了凸面dAVF在胚胎发育与静脉引流途径的血管弓之间的复杂关系，其中这种异常可能是后天获得的，由一条似乎是拉贝静脉的静脉内静脉压升高引起。了解胚胎学基础可能有助于更深入地理解后天性病变。
