硬脑膜动静脉瘘的头痛表型及可能机制

doi:10.3969/j.issn.1673-5765.2022.05.004

摘要/Abstract

摘要： 硬脑膜动静脉瘘是发生在颅内硬脑膜动脉和静脉之间异常交通的脑血管畸形。头痛作为其常见症状，临床表型多样，可表现为偏头痛样头痛和非偏头痛样头痛，并常伴有搏动性耳鸣、眼肌麻痹等，为诊断增加了难度。目前DSA仍然是硬脑膜动静脉瘘诊断和表征的“金标准”。保守治疗和血管内栓塞治疗减少硬脑膜动静脉瘘分流可有效缓解头痛症状。本文旨在对硬脑膜动静脉瘘的头痛表型特征、可能机制及治疗转归进行综述。

文章导读： 硬脑膜动静脉瘘头痛症状常见，表型多样，机制复杂，早期识别有助于及时诊断和治疗。

关键词: 硬脑膜动静脉瘘; 头痛; 机制; 治疗转归

Abstract: Dural arteriovenous fistula is an intracranial vascular malformation, typified by abnormal communication between meningeal arteries and dural venous sinuses or cortical veins. Headache is a common symptom with various clinical phenotypes, which makes the diagnosis more difficult. It can be manifested as migraine-like headache or non-migraine-like headache, often accompanied by pulsing tinnitus or ophthalmoplegia. At present, DSA is still the gold standard for diagnosis and characterization of dural arteriovenous fistula. Conservative treatment and endovascular embolization to reduce the shunt of dural arteriovenous fistula can effectively relieve headache symptoms. This article aimed to review the headache phenotypes, possible mechanisms and treatment outcomes of dural arteriovenous fistulas.

Key words: Dural arteriovenous fistula; Headache; Mechanism; Treatment outcome

陆佳洁, 赵红如. 硬脑膜动静脉瘘的头痛表型及可能机制[J]. 中国卒中杂志, 2022, 17(05): 461-465.

LU Jiajie, ZHAO Hongru. Headache Phenotypes and Possible Mechanisms of Dural Arteriovenous Fistula[J]. Chinese Journal of Stroke, 2022, 17(05): 461-465.

参考文献

[1] ELHAMMADY M S，AMBEKAR S，HEROS R C. Epidemiology，clinical presentation，diagnostic evaluation，and prog nosis of cerebral du ral arteriovenous fistulas[J/OL]. Handb Clin Neurol，2017，143：99-105[2021-12-04]. https://doi.org/10.1016/B978-0-444-63640-9.00009-6.
[2] MILLER T R，GANDHI D. Intracranial dural arteriovenous fistulae：clinical presentation and management strategies[J]. Stroke，2015，46（7）：2017-2025.
[3] REYNOLDS M R，LANZINO G，ZIPFEL G J. Intracranial dural arteriovenous fistulae[J]. Stroke，2017，48（5）：1424-1431.
[4] WANG S S，LI C H，ZHANG X J，et al. Investigation of the mechanism of dural arteriovenous fistula formation induced by high intracranial venous pressure in a rabbit model[J/OL]. BMC Neurosci，2014，15：101[2021-12-04]. https://doi.org/10.1186/1471-2202-15-101.
[5] CHEN P M，CHEN M M，MCDONALD M，et al. Cranial dural arteriovenous fistula[J/OL]. Stroke，2018，49（12）：e332-e334[2021-12-04]. https://doi. org/10. 1161/STROKEAHA. 118. 022508.
[6] YANG S J，YOU R，WU W F，et al. Dural arteriovenous fistula complicated with cerebral venous sinus thrombosis[J/OL]. World Neurosurg，2020，134：348-352[2021-12-04]. https://doi.org/10.1016/j.wneu.2019.10.075.
[7] I Z U MI T，MIYACHI S，HATTORI K，et al. Thrombophilic abnormalities among patients with cranial dural arteriovenous fistulas[J]. Neurosurgery，2007，61（2）：262-268.
[8] CHEN J G，LI Z X，ZHANG D F，et al. Cerebral venous sinus thrombosis complicated with acute development of dural arteriovenous fistula：a case report[J/OL]. J Clin Neurosci，2017，44：225-226[2021-12-04]. https://doi.org/10.1016/j.jocn.2017.06.011.
[9] FERRO J M，COUTINHO J M，JANSEN O，et al. Dural arteriovenous fistulae after cerebral venous thrombosis[J]. Stroke，2020，51（11）：3344-3347.
[10] Hea d ache Cla ssif icat ion Com m it tee of t he International Headache Society（IHS）. The international classification of headache disorders，3rd edition[J]. Cephalalgia，2018，38（1）：1-211.
[11] 朱文浩，汪明欢，朱遂强，等. 54例硬脑膜动静脉瘘的临床特点分析[J]. 神经损伤与功能重建，2016，11（3）：203-206.
[12] CORBELLI I，DE MARIA F，EUSEBI P，et al. Dural arteriovenous fistulas and headache features：an observational study[J]. J Headache Pain，2020，21（1）：6[2021-12-04]. https://doi.org/10.1186/s10194-020-1073-1.
[13] 魏慧星，杨锦珊，庄金红，等. 海绵窦区硬脑膜动静脉瘘的临床特点分析[J]. 中国神经精神疾病杂志，2017，43（12）：732-736.
[14] FLEMMING K D，LINK M J. Spontaneous CSF leak complicated by venous thrombosis and dural arteriovenous fistula[J]. Cephalalgia，2005，25（9）：751-753.
[15] CHANG Y H，LUO C B，WANG S J，et al. Cluster headache and middle meningeal artery dural arteriovenous fistulas：a case report[J]. Cephalalgia，2018，38（11）：1792-1796.
[16] NOM U R A M，MORI K，TAMASE A，et al. Cavernous sinus dural arteriovenous fistula patients presenting with headache as an initial symptom[J]. J Clin Med Res，2016，8（4）：342-345.
[17] GANDHI D，CHEN J，PEARL M，et al. Intracranial dural arteriovenous fistulas：classification，imaging findings，and treatment[J]. AJNR Am J Neuroradiol，2012，33（6）：1007-1013.
[18] SERULLE Y，MILLER T R，GANDHI D. Dural arteriovenous fistulae：imaging and management[J]. Neuroimaging Clin N Am，2016，26（2）：247-258.
[19] VA N ROOIJ W J，SLUZEWSKI M，BEU TE G N. Intracranial dural fistulas with exclusive perimedullary drainage：the need for complete cerebral angiography for diagnosis and treatment planning[J]. AJNR Am J Neuroradiol，2007，28（2）：348-351.
[20] ZHANG K，GAO B L，ZHU L F，et al. Endovascular recanalization of occluded dural sinus in patient with dural arteriovenous fistulas：case report and literature review[J/OL]. World Neurosurg，2018，114：269-273[2021-12-04]. https://doi.org/10.1016/j.wneu.2018.03.140.
[21] L E E S K，HETTS S W，HALBACH V，e t al. Standard and guidelines：intracranial dural arteriovenous shunts[J]. J Neurointerv Surg，2017，9（5）：516-523.
[22] TSAI L K，LIU H M，JENG J S. Diagnosis and management of intracranial dural arteriovenous fistulas[J]. Expert Rev Neurother，2016，16（3）：307-318.
[23] ZHANG S，WANG J J，LIU D，et al. Embolization of cavernous sinus dural arteriovenous fistula（CSDAVF）via transvenous approaches：practice，experience summary and literature review[J/OL]. J Clin Neurosci，2021，89：283-291[2021-12-04]. https://doi.org/10.1016/j.jocn.2021.05.005.
[24] OSAKA M，SHIBATA M，OKI K，et al. Clinical utility of triptans in the management of headache attributed to dural arteriovenous fistula involving the cavernous sinus[J]. J Neurol Sci，2015，349（1/2）：260-261.
[25] 王翠翠，邢英琦，徐忠良，等. 硬脑膜动静脉瘘疑诊颞动脉炎一例并文献复习[J]. 中国脑血管病杂志，2020，17（6）：333-335.
[26] KANTARCI M，BAYRAKTUTAN U，OZGÖKÇE M，et al. Cerebral dural arteriovenous fistula that causes intermittent headache[J]. Headache，2012，52（7）：1176-1177.