Kobayashi E, Wakamatsu K, Tominaga S
Department of Neurosurgery, Tominaga Neurosurgical Hospital.
No Shinkei Geka. 1994 Jul;22(7):643-8.
A case of dural arteriovenous malformation (DAVM) on the convexity adjacent to the superior sagittal sinus (SSS) was reported. A 55-year-old female was admitted to our hospital complaining of severe headache and intracranial bruit. CT scan revealed an osteolytic lesion at the right frontal bone adjacent to the SSS, and MRI showed a flow void area at the same site. Cerebral angiography detected DAVM which was fed by bilateral superficial temporal arteries and plenty of meningeal branches of the middle meningeal artery. It was drained by cortical veins to the SSS. Endovascular surgery was tried for this lesion, but it failed. After the surgical excision of DAVM, the above symptoms disappeared with no complications. The 14 cases reported in the literature were examined to characterize DAVM at this site. Average age was 47 with no age distribution. 43% of the cases had intracranial hemorrhage, subarachnoid hemorrhage (2), intracranial hemorrhage (2), intraventricular hemorrhage (1), and subdural hematoma (1). The DAVM arises most frequently at the middle third of the SSS and tends to extend to the posterior third. The symptom most frequently seen is headache, but we ought to pay attention to the possibility of progressive dementia. As for therapy, direct surgical excision is sometimes necessary if intravascular embolization ends in failure or incomplete cure.
报告了1例位于上矢状窦(SSS)旁凸面的硬脑膜动静脉畸形(DAVM)。一名55岁女性因严重头痛和颅内杂音入院。CT扫描显示右侧额骨靠近SSS处有骨质溶解病变,MRI显示同一部位有血流空洞区。脑血管造影检测到DAVM,由双侧颞浅动脉和脑膜中动脉的大量脑膜分支供血,经皮质静脉引流至SSS。对该病变尝试进行血管内手术,但失败了。DAVM手术切除后,上述症状消失,无并发症。对文献报道的14例病例进行分析,以明确该部位DAVM的特征。平均年龄47岁,无年龄分布差异。43%的病例发生颅内出血,包括蛛网膜下腔出血(2例)、颅内出血(2例)、脑室内出血(1例)和硬膜下血肿(1例)。DAVM最常发生于SSS的中1/3段,并倾向于向后1/3段延伸。最常见的症状是头痛,但我们应注意进行性痴呆的可能性。至于治疗,如果血管内栓塞失败或未完全治愈,有时需要直接手术切除。