| 摘要: |
| 目的 总结脑膜中静脉硬脑膜动静脉瘘（MMV-DAVF）的临床表现、影像学特点和治疗情况。方法 回顾性收集我院1999年1月至2020年4月收治的9例MMV-DAVF患者资料，并利用数据库检索1960年1月1日至2020年8月30日中英文文献16篇共23例MMV-DAVF患者资料，汇总分析32例MMV-DAVF患者的临床表现、影像学特点、治疗情况。结果 我院9例MMV-DAVF患者中，7例有明确的头部外伤史，头痛（5例）、颅内杂音（5例）是最常见的临床表现。6例患者有CT检查资料，其中4例合并颅骨骨折，5例有颅内血肿。9例患者均经脑膜中静脉引流至邻近静脉窦或静脉丛，均行经脑膜中动脉入路注射Onyx-18胶血管内介入治疗，7例术后即刻瘘口完全栓塞，2例次全栓塞；4例患者完成术后半年随访，均未见DAVF复发和新发。综合文献报道和我院共32例患者资料，26例（81.2%）有明确的头部外伤史。16例（50.0%）表现为头痛，12例（37.5%）伴有颅内杂音。25例患者有CT检查资料，其中21例（84.0%）合并颅骨骨折，16例（64.0%）伴颅内血肿。20例（62.5%）患者接受经脑膜中动脉入路血管内介入治疗，16例（80.0%）术后即刻瘘口完全栓塞，其中7例有术后半年影像学随访资料，均未出现DAVF复发和新发。结论 MMV-DAVF发病率低，患者多有外伤史，常合并颅骨骨折和颅内血肿，经脑膜中动脉入路栓塞治疗有较高的安全性和有效性。 |
| 关键词: 硬脑膜动静脉瘘 脑膜中静脉 血管内治疗 脑膜中动脉 颅骨骨折 头部损伤 |
| DOI：10.16781/j.0258-879x.2020.10.1157 |
| 投稿时间：2020-09-23修订日期：2020-10-12 |
| 基金项目:国家自然科学基金面上项目（81771266），上海市科学技术委员会科研计划项目（17411971600）． |
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| Middle meningeal vein dural arteriovenous fistula: a report of nine cases and literature review |
| WANG Yang,LIU Pei,LI Jia-nan,FANG Yi-bin,HONG Bo,XU Yi,LI Qiang,LIU Jian-min* |
(Stroke Center, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To summarize the clinical symptoms, imaging features and endovascular treatment outcomes of the middle meningeal vein dural arteriovenous fistula (MMV-DAVF). Methods The data of nine MMV-DAVF patients admitted to our hospital from Jan. 1999 to Apr. 2020 were retrospectively collected. A total of 16 Chinese and English articles, including 23 cases of MMV-DAVF, were retrieved from the database between Jan. 1, 1960 and Aug. 30, 2020. The clinical symptoms, imaging features and endovascular treatment outcomes were analyzed. Results Of the nine MMV-DAVF patients in our hospital, seven patients had a clear history of head trauma. Headache (five cases) and intracranial murmur (five cases) were the most common clinical symptoms. Six patients had computed tomography (CT) data, and four of them had skull fracture and five had intracranial hemorrhage. All the nine patients were drained from the middle meningeal vein (MMV) to adjacent venous sinus or venous plexus. The nine patients were treated with Onyx-18 glue endovascular intervention via middle meningeal artery (MMA) approach, and seven patients had complete embolization immediately after operation and two had subtotal embolization. No recurrence or new onset of DAVF was found in four patients having CT data half a year after operation. Among the 32 patients from our hospital and literatures, 26 patients (81.2%) had a clear history of head trauma, 16 patients (50.0%) suffered from headache, and 12 patients (37.5%) suffered from intracranial murmur. Twenty-five patients had CT data, including 21 patients (84.0%) with skull fracture, 16 patients (64.0%) with intracranial hematoma. Twenty patients (62.5%) were treated with endovascular interventional therapy via MMA approach, and 16 patients (80.0%) had complete embolization immediately after operation. Among them, seven cases had imaging follow-up data half a year after operation, and no recurrence or new onset of DAVF was found. Conclusion MMV-DAVF is rare, and many patients have head trauma history combined with skull fracture or intracranial hematoma. Endovascular embolization via MMA approach is safe and effective in treating MMV-DAVF. |
| Key words: dural arteriovenous fistula middle meningeal vein endovascular treatment middle meningeal artery skull fractures head injuries |
