摘要
目的探讨以自发性蛛网膜下腔出血为首发症状左迷走锁骨下动脉多发动静脉瘘的临床表现、诊断及治疗经验。方法回顾性分析1例以自发性蛛网膜下腔出血为首发症状左迷走锁骨下动脉多发动静脉瘘患者的临床资料。结果本例头部CT示蛛网膜下腔出血伴脑室出血,320排CTA及DSA诊断为左迷走锁骨下动脉多发动静脉瘘,行弹簧圈、ONYX胶联合真丝线段栓塞治疗。术后患者恢复良好,未发生其他并发症。术后8 d复查320排CTA见降主动脉弓迷走血管仅留残端,瘘完全消失。结论左迷走锁骨下动脉多发动静脉瘘是一种罕见血管性疾病,3D-DSA仍是诊断动静脉瘘的金标准,治疗成功的关键必须先控制供血迷走动脉血流,再栓塞或夹闭瘘口,要彻底治愈本病必须闭塞瘘口。
Objective To explore the clinical characteristics, diagnosis and treatment exprience of spontaneous subarachnoid hemorrhage （SAH） resulting from multiple arteriovenous fistula （AVF） of aberrant left subclavian artery （ALSA）. Method The clinical data of one patient with spontaneous SAH resulting from multiple AVF of ALSA were analyzed retrospectively. Results The patient （male, aged 26 years） presented with spontaneous SAH as the initial manifestation. The CT imaging showed SAH and intraventricular hemorrhage and the MRI showed eroded flow voids at the level of C2-3. The patient was definitely diagnosed by 320-slice computed tomography angiography （320-CTA） and DSA which showed that the descending aorta issued an abnormal vagus artery with a diameter of 9 mm at the lateral side of the left subclavian artery and the AVF was drained by one vein to the brain through vertebral vein and by another vein to venae cava superior through the left innominate vein. The patient was eventually treated by embolization with coils, Onyx glue and silk thread and the 320-CTA 8 days after embolization showed that the orificium fistulae were completely occluded. Conclusions The intraspinal vascular lesions even other rare causes should be considered in patients with spontaneous SAH when the DSA dose not find intracranial vascular lesions. The 3D-DSA is the gold standard for the diagnosis of multiple AVF of ALSA. The embolization can achieve good prognosis in patients with multiple AVF of ALSA.
出处
《中国临床神经外科杂志》
2013年第9期527-530,共4页
Chinese Journal of Clinical Neurosurgery
关键词
自发性蛛网膜下腔出
左迷走锁骨下动脉
动静脉瘘
Spontaneous subarachnoid hemorrhage
Aberrant left subclavian artery
Arteriovenous fistula
作者简介
通讯作者：马廉亭，Email：mltl937@163．com
