Payman Andre, Rios Zermeno Jorge, Bartoletti Viola, Norri Nicolo, Abla Adib A, Rodriguez Rubio Roberto
Neurological Surgery, University of California San Francisco, San Francisco, USA.
Neurological Surgery, Mayo Clinic, Jacksonville, USA.
Cureus. 2024 Jul 14;16(7):e64532. doi: 10.7759/cureus.64532. eCollection 2024 Jul.
Dural arteriovenous fistulas (dAVFs) are anomalous connections between arteries and veins within the dura mater, involving dural sinuses, bridging veins, or emissary veins. If untreated, these lesions can result in intracranial hemorrhage. The management of posterior fossa dAVFs is challenging due to the intricate venous anatomy near the brainstem and cranial nerves. This study leverages three-dimensional (3D) technology combined with dissections to understand the anatomy and microsurgical techniques for treating infratentorial dAVFs. Five embalmed heads and one dry skull were used to meticulously document the pertinent anatomy of the infratentorial compartment. Advanced 3D technology, including 3D sculpting and structured light scanning, was employed to construct high-resolution volumetric models (VMs). Two-dimensional (2D) images of dissections and VMs illustrate key anatomical landmarks of the posterior fossa. Infratentorial dAVFs primarily involve sinuses, which are divided into groups based on their location: basal, medullary, and petrosal. Most of the arterial supply originates from the external carotid artery, especially the ascending pharyngeal artery. This is followed by meningeal branches from the internal carotid artery (ICA) and vertebrobasilar system. The surgical approaches to treat infratentorial dAVFs include the retrosigmoid and far lateral approaches and their modifications. Our study describes the relevant vascular anatomy of the infratentorial compartment, focusing on the surgical treatment of infratentorial dAVFs. In conjunction with the included interactive models, this study improves our educational capabilities regarding the intricate vascular neuroanatomical features of this region. When applied to a clinical setting, precise anatomical knowledge and VMs tools enhance surgical outcomes, reduce complications, and ultimately improve patient care.
硬脑膜动静脉瘘（dAVF）是硬脑膜内动脉与静脉之间的异常连接，涉及硬脑膜窦、桥静脉或导静脉。如果不进行治疗，这些病变可导致颅内出血。由于脑干和颅神经附近复杂的静脉解剖结构，后颅窝dAVF的治疗具有挑战性。本研究利用三维（3D）技术结合解剖来了解幕下dAVF的解剖结构和显微外科技术。使用五个防腐处理的头部和一个干燥颅骨来详细记录幕下腔室的相关解剖结构。采用先进的3D技术，包括3D雕刻和结构光扫描，构建高分辨率容积模型（VM）。解剖和VM的二维（2D）图像展示了后颅窝的关键解剖标志。幕下dAVF主要累及窦，根据其位置分为基底、延髓和岩骨组。大部分动脉供应来自颈外动脉，尤其是咽升动脉。其次是来自颈内动脉（ICA）和椎基底系统的脑膜分支。治疗幕下dAVF的手术入路包括乙状窦后入路和远外侧入路及其改良。我们的研究描述了幕下腔室的相关血管解剖结构，重点是幕下dAVF的外科治疗。结合所包含的交互式模型，本研究提高了我们对该区域复杂血管神经解剖特征的教学能力。当应用于临床时，精确的解剖学知识和VM工具可提高手术效果、减少并发症，并最终改善患者护理。
