How to treat dural arteriovenous malformations or fistulas
How to treat dural arteriovenous malformations or fistulas
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如何治疗硬脑膜动静脉畸形或瘘管
DOI：
10.1007/s003290050084
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Mori
中科院分区：
文献类型：
--
作者：
Morimoto;Mori
颅内硬膜动静脉瘘（AVFs）的临床症状主要取决于病变部位和静脉引流方式。治疗病变的目标是永久和完全消除动静脉分流。经动脉栓塞或立体定向放射可能影响供血动脉或病灶。受累的鼻窦可以通过经皮或手术经静脉栓塞清除，或手术切除。对于单纯脑膜轻脑膜引流的患者，手术中断脑膜轻脑膜引流可能有效。根据文献报道的经验，经动脉栓塞可达的供血动脉是减少动脉血流的初始治疗方法。经静脉栓塞可能有效取决于静脉引流模式。对于经动脉栓塞后残留的avf，如果可行，建议进行立体定向放射手术。考虑到静脉高压和颅内出血的风险，应谨慎应用经静脉栓塞。如果立体定向放射手术不安全，则建议直接显微手术。对于没有硬脑膜窦引流的病例，手术中断脑膜窦引流是安全的。对硬脑膜avf进行干预的决定是基于以下因素：患者的年龄和一般状况、出现症状的严重程度、如果不进行治疗，病变的自然病史、硬脑膜avf位置的血管造影特征和静脉引流模式，以及手术的发病率和死亡率。
The clinical symptoms of intracranial dural arteriovenous fistulas (AVFs) depend mainly on the site and venous drainage pattern of the lesion. The goal of treatment of the lesion is the permanent and complete elimination of the arteriovenous shunt. Transarterial embolization or stereotactic radiation may affect feeding arteries or nidus. The involved sinus can be obliterated by percutaneous or surgical transvenous embolization, or resected by surgery. In cases of patients with pure leptomeningeal drainage, surgical interruption of leptomeningeal drainage may be effective. Based on the experiences reported in the literature, transarterial embolization of accessible feeding arteries is the initial treatment to decrease arterial blood flow. Transvenous embolization may be effective depending on the venous drainage pattern. For the AVFs remaining after transarterial embolization, stereotactic radiosurgery is recommended if feasible. Transvenous embolization may be applied cautiously considering the risk of venous hypertension and intracranial hemorrhage. Direct microsurgery is indicated if stereotactic radiosurgery is not performed safely. For cases without dural sinus drainage, surgical interruption of leptomeningeal drainage may be applied safely. The decision to intervene in dural AVFs is based on the following factors: age and general condition of the patient, severity of the presenting symptoms, natural history of the lesion if left untreated, angiographic features on the location of dural AVFs and the venous drainage pattern, and morbidity and mortality of the procedure being considered.