Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases
Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases
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DOI：
10.1007/s00234-008-0393-7
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发表时间：
2008-08-01
期刊：
影响因子：
2.8
通讯作者：
Nagahiro, Shinji
中科院分区：
文献类型：
--
作者：
Manabe, Shinji;Satoh, Koichi;Nagahiro, Shinji
介绍我们报告的特点，诊断和治疗舌下神经管硬脑膜动静脉瘘（DAVF）在9例相对罕见的血管disorder.Methods在我们的机构管理的248例颅内DAVF，9例（3.6%; 4男，5女;平均年龄62岁）被诊断为舌下神经管DAVF。我们调查了患者的临床症状，神经放射学检查结果，疗效和并发症血管内treatment.Results 7例患者经历了头部损伤的特点。所有患者均表现为搏动性耳鸣。1例患者在治疗前出现同侧舌下神经麻痹。磁共振血管造影显示了“魔术棒”的外观之间的影响舌下神经管和颈内静脉的四个病人。血管造影显示上级颈静脉球内侧有动静脉瘘，主要来自双侧枕动脉、咽升动脉和椎动脉，经前髁静脉引流至颈内静脉。侧颈动脉注射准确地阐明了分流点。5例患者接受了血管内治疗：经动脉栓塞（TAE; n= 2）、经静脉栓塞（TVE; n= 2）和TAE/TVE（n= 1）。4例患者实现了完全分流闭塞，1例患者实现了分流减少。其余4例患者接受保守治疗，随访时分流消失。1例TVE术后出现舌下神经麻痹，可能与弹簧圈过度填塞有关。结论舌下神经管DAVF的发生率并不低。侧颈动脉注射是提供准确诊断的必要检查。尽管TAE也适用于分流减少术，但在有通路时应考虑TVE。
Introduction We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder.Methods Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment.Results Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a "magic wand" appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n= 2), transvenous embolization (TVE; n= 2), and TAE/TVE (n= 1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking.Conclusion The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction.