Momoji J, Mukawa J, Yamashiro K, Ishikawa Y, Okuyama K, Toda T
Department of Neurosurgery, Okinawa Prefectural Miyako Hospital.
No Shinkei Geka. 1997 Feb;25(2):137-42.
Two cases of dural arteriovenous malformation (DAVM) of the posterior fossa were presented and a histopathological examination was described. After embolization of the feeding arteries, DAVMs of the posterior fossa were removed with the adjacent sinus. Serial sections of the surgical specimens showed an abnormal mass with dilated, tortuous vessels of varying diameters in the sinus wall, and partially hyalinized connective tissue around the vessels. The elastic lamina of the sinus wall was interrupted and a mass of abnormal vessels developed into the subintimal layer of the sinus. Fistulas, about 200 microns in diameter, were formed between arterialized dural veins and dural arteries which had obvious internal elastic lamina. An opening of the fistula of the abnormal vessel, 25 microns in diameter, to the sinus lumen was also seen. No stage of organized thrombus could be seen in the sinus lumen. These findings strongly suggested that physiologically existing arteriovenous fistulas within the dura mater, which have been reported by Kerber et al, had developed due to many factors which increase intracranial pressure. They protruded into the sinus lumen in such a way that it could cause stenosis or obstruction of the sinus. In conclusion it can be said that an obstructive lesion of dural sinus is considered of itself to be DAVM in most cases and sinus thrombosis is the result of the DAVM.
本文报告了两例后颅窝硬脑膜动静脉畸形（DAVM）病例，并描述了组织病理学检查结果。在栓塞供血动脉后，将后颅窝DAVM与相邻的静脉窦一并切除。手术标本的连续切片显示，在静脉窦壁有一个异常肿块，伴有直径各异的扩张、迂曲血管，血管周围有部分玻璃样变的结缔组织。静脉窦壁的弹性膜中断，一团异常血管延伸至静脉窦的内膜下层。在有明显内弹性膜的动脉化硬脑膜静脉与硬脑膜动脉之间形成了直径约200微米的瘘管。还可见一条直径25微米的异常血管瘘口通向静脉窦腔。在静脉窦腔内未见机化血栓阶段。这些发现强烈提示，Kerber等人报道的硬脑膜内生理存在的动静脉瘘，是由于多种增加颅内压的因素发展而来。它们以可导致静脉窦狭窄或阻塞的方式突入静脉窦腔。总之，可以说在大多数情况下，硬脑膜静脉窦的阻塞性病变本身被认为是DAVM，而静脉窦血栓形成是DAVM的结果。
