- 期刊
Surgical Treatment of Anterior Cranial Fossa Dural Arteriovenous Fistula - Report of Two Cases
前顱窩硬腦膜動靜脈瘻管之外科治療一二病例報告
摘要
前顱窩硬腦膜動靜脈瘻管是少見的疾病，在本研究報告中，我們提出以外科手術治療二位病人的經驗。第一位病人是一位46歲的男性，他發生二次全身性癲癇發作，腦部磁振攝影檢查顯示病人又側額部有異常的血管，二側頸動脈血管攝影發現再前顱窩有一硬腦膜動靜脈瘻管，其灌流動脈來自二側篩前動脈、腦膜中動脈、及顳淺動脈，靜脈引流則是經由右側額葉的皮質靜脈，然後進入上矢壯竇，而且這些皮質靜脈有彭大現象。病人接受手術將灌流動脈及引流靜脈切斷，但並未切除病灶，手術後一年的血管攝影檢查顯示無殘餘或再發的硬腦膜動靜脈瘻管，經五年的追蹤，這位病患除了曾發生一次癲癇外其他情況良好。另一位病人是一位62歲的男性，他突然發生頭痛、嘔吐、及意識不清現象，腦部電腦斷層掃描攝影發現其右側額部有腦內出血，電腦斷層血管攝影發現有不正常血管，頸動脈血管攝影顯示前顱窩有一硬腦膜動靜脈瘻管，其灌流動脈來自右側篩前動脈，靜脈引流則是經由右側額葉的皮質靜脈，然後進入上矢壯竇，而且這些靜脈有彭大現象。病人接受手術清除血塊，並將病灶切除，手術後血管攝影檢查顯示無殘餘的硬腦膜動靜脈瘻管，經壹年半的追蹤，這位病患情況良好。根據治療這二位病人的經驗及文獻上資料，我們將探討前顱窩硬腦膜動靜脈瘻管的手術治療方式的選擇。(慈濟醫學 2003; 15:199-204)
並列摘要
Anterior cranial fossa dural arteriovenous fistula (DAVF) is uncommon. In this report, we present two patients with anterior cranial fossa DAVF. The first patient was a 46-year-old man who had had two episodes of generalized tonic-clonic seizure. Magnetic resonance imaging revealed abnormal vasculature in the right anterior frontal area and bilateral carotid angiogram demonstrated a DAVF in the right anterior cranial fossa. The feeding arteries were from the bilateral anterior ethmoid arteries, middle meningeal arteries, and superficial temporal arteries. The venous drainage was through the cortical veins of the right frontal lobe and then the superior sagittal sinus. Venous ectasia was also noted. During surgery, the feeding arteries from the external carotid artery were divided and the leptomeningeal draining veins were interrupted without excision of the nidus. Angiography one year after surgery revealed no residual DAVF. The patient was doing well after five years of follow-up except for one episode of seizure. The other patient was a 62-year-old man who suffered sudden onset of severe headache with vomiting and consciousness disturbance. Brain computed tomography (CT) scanning revealed intracerebral hemorrhage in the right frontal lobe. A CT angiogram showed abnormal vasculature and a carotid angiogram demonstrated an anterior cranial fossa DAVF with a feeding artery from the right anterior ethmoid artery. The venous drainage was through a cortical draining vein in the right frontal lobe and finally the superior sagittal sinus. Venous ectasia was also noted. The patient underwent surgery to remove the intracerebral hematoma and excise the DAVF. Post-operative angiography showed no residual DAVF. The patient was in good condition after one and one half years of follow-up. (Tzu Chi Med J 2003; 15:199-204)
延伸閱讀
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