CAJ | 학술논문

目的探讨硬脑膜动静脉瘘（dural arteriovenous fistula，DAVF）的可能危险因素、临床、神经影像特点及治疗策略。 　　方法回顾性分析2009年10月～2012年12月期间北京天坛医院神经内科连续收治住院的27例DAVF患者，收集患者的起病方式、危险因素、首发症状、神经影像特点及治疗方式等资料并进行分析。 　　结果27例DAVF患者中急性起病13例（48.1％），其中合并脑出血/蛛网膜下腔出血者10例（37％），颅内静脉窦血栓形成及高同型半胱氨酸血症者各3例（11.1%），首发症状为头痛者11例（40.7％）；亚急性起病3例（11.1％），其中合并颅内静脉窦血栓形成者1例（3.7％），首发症状为肢体瘫痪/失语者各1例（3.7％）；慢性病程11例（40.7％），其中合并颅内静脉窦血栓形成、脑出血/蛛网膜下腔出血者各5例（18.5％），高同型半胱氨酸血症者3例（11.1%），首发症状为头痛或眼部症状者各5例（18.5％）。其中19例患者行颅脑计算机断层扫描（computed tomography，CT），3例提示DAVF可能；18例患者行颅脑磁共振成像（magnetic resonance imaging，MRI），7例提示DAVF可能；26例患者完成数字减影血管造影（digital subtraction angiography，DSA）检查，均被确诊为DAVF。本组患者中动静脉瘘口位置以横窦、乙状窦及海绵窦区最为多见。接受血管内栓塞治疗14例（51.9％），建议观察或择期血管内栓塞治疗7例（25.9％），外科手术治疗2例（7.4％），放弃治疗4例（14.8％）。 　　结论不同起病形式的DAVF伴随疾病不同，临床表现多样；DSA具有诊断优势；血管内栓塞可以作为DAVF的有效治疗手段之一。
목적탐토경뇌막동정맥루（dural arteriovenous fistula，DAVF）적가능위험인소、림상、신경영상특점급치료책략。 　　방법회고성분석2009년10월～2012년12월기간북경천단의원신경내과련속수치주원적27례DAVF환자，수집환자적기병방식、위험인소、수발증상、신경영상특점급치료방식등자료병진행분석。 　　결과27례DAVF환자중급성기병13례（48.1％），기중합병뇌출혈/주망막하강출혈자10례（37％），로내정맥두혈전형성급고동형반광안산혈증자각3례（11.1%），수발증상위두통자11례（40.7％）；아급성기병3례（11.1％），기중합병로내정맥두혈전형성자1례（3.7％），수발증상위지체탄탄/실어자각1례（3.7％）；만성병정11례（40.7％），기중합병로내정맥두혈전형성、뇌출혈/주망막하강출혈자각5례（18.5％），고동형반광안산혈증자3례（11.1%），수발증상위두통혹안부증상자각5례（18.5％）。기중19례환자행로뇌계산궤단층소묘（computed tomography，CT），3례제시DAVF가능；18례환자행로뇌자공진성상（magnetic resonance imaging，MRI），7례제시DAVF가능；26례환자완성수자감영혈관조영（digital subtraction angiography，DSA）검사，균피학진위DAVF。본조환자중동정맥루구위치이횡두、을상두급해면두구최위다견。접수혈관내전새치료14례（51.9％），건의관찰혹택기혈관내전새치료7례（25.9％），외과수술치료2례（7.4％），방기치료4례（14.8％）。 　　결론불동기병형식적DAVF반수질병불동，림상표현다양；DSA구유진단우세；혈관내전새가이작위DAVF적유효치료수단지일。
Objective To discuss the potential risk factors, clinical and neuroimaging characteristics and the treatment of dural arteriovenous ifstula (DAVF). Methods The clinical data of 27 cases of DAVF that comes from the continuous hospitalization patients at the Department of Neurology of Beijing Tiantan Hospital from October 2009 to December 2012, including onset styles, risk factors, initial symptoms, neuroimaging characteristics and treatment modalities, were retrospectively analyzed. Results In the 27 cases of DAVF, 13 (48.1%) cases were with acute onset and in which 10 (37%) cases were with the concomitant disease of cerebral hemorrhage or subarachnoid hemorrhage, 3 (11.1%) cases were with the concomitant diseases of thrombosis of intracranial venous sinus and hyperhomocysteinaemia respectively and 11 (40.7%) cases were with the initial symptom of headache. In the 27 cases of DAVF, 3 (11.1%) cases were with subacute onset and in which 1 (3.7%) case was with the concomitant disease of thrombosis of intracranial venous sinus and 1 (3.7%) case was with the initial symptom of limb paralysis or aphasia respectively. In the 27 cases of DAVF, 11 (40.7%) cases were with chronic course and in which 5 (18.5%) cases were with the concomitant disease of cerebral hemorrhage or subarachnoid hemorrhage or thrombosis of intracranial venous sinus respectively, 3 (11.1%) cases were with the concomitant diseases of hyperhomocysteinaemia and 5 (18.5%) cases were with the initial symptom of headache or ocular symptoms respectively. In the 27 cases of DAVF, 19 cases had received brain CT scanner and in which 3 cases had been revealed the possibility of DAVF;18 cases had received brain MRI scanner and in which 7 cases had been revealed the possibility of DAVF;26 cases had received the examination of DSA and all of cases had been made a deifnite diagnosis of DAVF. Transverse-sigmoid sinus and cavernous sinus as the oriifces of DAVF were more common in this essay. In the 27 cases of DAVF, 14 (51.9%) cases had adopted endovascular embolization;7 (25.9%) cases with observation or selective therapy of endovascular embolization;2 (7.4%) cases had adopted the surgical treatment;4 (14.8%) cases had given up the treatment. Conclusion DAVF has different concomitant diseases with different onset styles. The clinical characteristics of DAVF are multiplicity. DSA has advantages for the diagnosis of DAVF. Endovascular embolization may be one of the effective therapies for DAVF.