颅颈结合区硬脑膜动静脉瘘的临床和影像学特征

doi:10.3969/j.issn.1673-5765.2019.06.010

摘要/Abstract

摘要：

目的总结颅颈结合部硬脑膜动静脉瘘（dural arteriovenous fistula，DAVF）患者的影像学和临床特征。方法回顾性分析2005年8月-2016年7月在成都市第五人民医院经DSA确诊的16例颅颈结合部 DAVF患者临床资料及其DSA、CTA和MRI影像信息。根据发病时间将患者分成急性（7 d内）、亚急性（1 个月内）和慢性（超过1个月）三组。结果确诊的患者急性组4例、亚急性组4例和慢性组8例，其中急性和慢性患者中男性比例均为 75.0%，高于亚急性患者（50.0%）。在静脉引流方向上，有7例（87.5％）的慢性患者引流方向向上，而急性和亚急性患者静脉引流向上的比例分别为3例（75.0%）和2例（50.0%）。所有患者在临床上均出现头痛、恶心等非特异性症状。DSA影像显示DAVF在颅颈结合区集中在C1神经根处、双侧乙状窦处、横窦区、右脑膜后动脉近横窦处、右侧硬脊膜动静脉瘘瘘口、左/右侧椎动脉区、枕大孔区、右侧脑膜中动脉分支、窦汇区、天幕区和双侧海绵窦。5例患者接受了CTA检查，其中4例CTA影像呈阳性，显示出蛛网膜下腔出血或血管的数目、形状和粗细上的改变；12例患者行脊髓MRI平扫检查，均显示被检者出现异常流空血管，并在脑实质区出现异常信号。结论颅颈结合部DAVF的临床表现与颅颈结合部位置无关，与静脉引流的方向有关，CTA和MRI有助于DAVF诊断，但确诊需要DSA检查。

文章导读： CTA和MRI检查可以帮助临床医师对DAVF进行预判，DSA则有助于对该病的确诊，分型及后期治疗方案的确定。因此，提高对DAVF患者临床特征，CTA、MRI和DSA影像的认识有助于对DAVF患者进行及时准确的诊断并制订适宜的治疗方案。

关键词: 硬脑膜动静脉瘘; 颅颈结合区; 数字减影血管造影; 蛛网膜下腔出血

Abstract:

Objective To evaluate the imaging and clinical features of myelopathy caused by dural arteriovenous fistula (DAVF) in craniocervical junction. Methods The clinical and imaging data (including DSA, CTA and MRI) of 16 patients with DAVF in craniocervical junction from Chengdu Fifth People’s Hospital from August 2005 to July 2016 were retrospectively analyzed. All patients were diagnosed by digital subtraction angiography (DSA). 4 cases underwent CTA and 12 cases underwent MRI. According to the time of onset, 16 patients were divided into acute (within 7 days of onset), subacute (within 1 month of onset) and chronic (beyond 1 month of onset) groups. Results 4 cases in acute group, 4 cases in subacute group and 8 cases in chronic group. The proportions of male in acute and chronic patients were both 75.0%, which was higher than that in subacute patients (50.0%). In terms of the direction of venous drainage, 87.5% of chronic patients (7 cases) had ascending venous draining, while 75.0% of acute and 50.0% of subacute patients had similar direction pattern. Nonspecific symptoms, such as headache, dizziness, nausea and vomiting were observed in all patients. DSA images showed that DAVF was primarily located in C1 nerve root, right dural arteriovenous fistula, bilateral sigmoid sinus, transverse sinus, right posterior meningeal artery near transverse sinus, right dural arteriovenous fistula orifice, left/right vertebral artery area, occipital foramen area, right middle meningeal artery branch, sinus confluence area, tentorium area and bilateral cavernous sinus. 4/5 patients who underwent CTA examination showed positive, and the CTA displayed subarachnoid hemorrhage, as well as the number, shape and thickness of the vessels. 12 patients received MRI scan, abnormal vessel flow void signal and abnormal signal in brain parenchymal area were displayed on MRI. Conclusions The clinical characteristics of DAVF in craniocervical junction is related to the direction of venous drainage, not the location of arteriovenous fistula; CTA and MRI are helpful to diagnose DAVF, while the final diagnosis of DAVF is confirmed by DSA.

Key words: Dural arteriovenous fistula; Craniocervical junction; Digital subtraction angiography; Subarachnoid hemorrhage

李黎，刘俊，杨智，兰亚. 颅颈结合区硬脑膜动静脉瘘的临床和影像学特征[J]. 中国卒中杂志, 2019, 14(06): 573-577.

LI Li, LIU Jun,YANG Zhi, LAN Ya. Clinical and Imaging Features of Dural Arteriovenous Fistula in Craniocervical Junction[J]. Chinese Journal of Stroke, 2019, 14(06): 573-577.

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