Arai T, Ohno K, Yoshino Y, Tanaka Y, Nariai T, Hirakawa K, Nemoto S
Department of Neurosurgery, Tokyo Medical and Dental University.
No Shinkei Geka. 1997 Jul;25(7):621-6.
A rare case of dural arteriovenous fistula (DAVF) in the superior sagittal sinus (SSS), the transverse sinus and the sigmoid sinus is reported. A 64-year-old man, who had had an episode of temporary visual disturbance after moderate fever for a week about 20 years before, was aware of loss of visual acuity and reduced field of view in the right eye. When he was introduced to our outpatient service, increased intracranial pressure (ICP) was detected by lumbar puncture. Cerebral angiograms showed bilateral DAVFs both in the posterior fossa and the SSS concomitant with thrombosis in the transverse sinus, sigmoid sinus and SSS. Afterwards, endovascular transarterial embolization through bilateral occipital, posterior auricular and left middle meningeal, superior temporal arteries was carried out. In addition, transvenous thrombolytic therapy using a catheter inserted into SSS resulted in the improvement of his visual problems. Although he was discharged at once, he was readmitted to our department with Foster Kennedy syndrome and increased ICP. Cerebral angiograms showed recurrence of both DAVF and sinus thrombosis. Transarterial embolization was performed again resulting in a significant reduction of DAVF, and his visual acuity was recovered to a moderate degree. The origin of DAVF is still controversial. Although two theories, "congenital" and "acquired", are put forward, it has been thought that both factors play important roles. In our case, the patient had stenosis in the jugular canal portions of the sigmoid sinus. In addition, sinus thrombosis seemed to have occurred. It is thought that increased intrasinus pressure may have lead to communication with surrounding arteries through existing dural vessels. We applied transvenous thrombolytic therapy in this case. Our result suggests that we should consider this therapy for some cases of DAVF.
报告了一例罕见的上矢状窦、横窦和乙状窦硬脑膜动静脉瘘（DAVF）。一名64岁男性，约20年前在中度发热一周后曾有过一次短暂性视觉障碍发作，现意识到右眼视力丧失和视野缩小。当他被介绍到我们的门诊时，通过腰椎穿刺检测到颅内压（ICP）升高。脑血管造影显示后颅窝和上矢状窦均存在双侧DAVF，并伴有横窦、乙状窦和上矢状窦血栓形成。此后，通过双侧枕动脉、耳后动脉以及左脑膜中动脉、颞上动脉进行了血管内动脉栓塞。此外，通过插入上矢状窦的导管进行静脉溶栓治疗，改善了他的视觉问题。尽管他立即出院，但因福斯特·肯尼迪综合征和颅内压升高再次入住我科。脑血管造影显示DAVF和窦血栓形成均复发。再次进行动脉栓塞，导致DAVF显著减少，其视力恢复到一定程度。DAVF的起源仍存在争议。虽然提出了“先天性”和“后天性”两种理论，但人们认为这两个因素都起着重要作用。在我们的病例中，患者乙状窦颈静脉管段存在狭窄。此外，似乎发生了窦血栓形成。据认为，窦内压力升高可能导致通过现有的硬脑膜血管与周围动脉相通。我们在该病例中应用了静脉溶栓治疗。我们的结果表明，对于某些DAVF病例应考虑这种治疗方法。
