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首页> 外文期刊>Neurosurgery >Conus perimedullary arteriovenous fistula with intracranial drainage: case report.
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Conus perimedullary arteriovenous fistula with intracranial drainage: case report.

机译：圆锥形动静脉瘘伴颅内引流：病例报告。

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摘要

OBJECTIVE AND IMPORTANCE: Perimedullary arteriovenous fistulae (AVFs) do not commonly present with subarachnoid hemorrhage or intracranial venous drainage causing neurological symptoms. We present a case with both of these features. The patient was inadvertently treated for an unruptured intracranial aneurysm before his true problem was recognized. CLINICAL PRESENTATION: A 65-year-old man presented with sudden-onset lower-extremity weakness, diplopia, nausea, and dysarthria on the day of admission. A lumbar puncture documented subarachnoid hemorrhage, and imaging studies revealed a left middle cerebral artery aneurysm. It was noted during surgery that this aneurysm was unruptured, and the patient did not exhibit improvement after surgery. INTERVENTION: Spinal angiography demonstrated a spinal perimedullary AVF feeding from the left T12 radicular artery; venous drainage extended rostrally into the posterior fossa venous system. The AVF was surgically occluded via a posterior laminectomy at the level of the AVF. After surgery, the patient's symptoms began to abate. CONCLUSION: Conus perimedullary AVFs can have venous drainage that extends as far as intracranial veins, which can lead to confusing clinical findings because the symptoms may suggest an intracranial process, although the lesion is in the spine. Surgeons must be aware of this confusing presentation.
机译：目的和重要性：蛛网膜下腔动静脉瘘（AVF）通常不伴有蛛网膜下腔出血或颅内静脉引流，从而引起神经系统症状。我们介绍了具有这两个功能的案例。在真正的问题被确认之前，该患者未经治疗而未破裂的颅内动脉瘤。临床表现：一名65岁的男子在入院当天出现突然发作的下肢无力，复视，恶心和构音障碍。腰椎穿刺记录了蛛网膜下腔出血，影像学检查显示左大脑中动脉瘤。注意到在手术期间该动脉瘤未破裂，并且患者在手术后没有表现出改善。干预：脊柱血管造影显示从左T12根神经动脉进出的脊柱髓周围AVF。静脉引流向后延伸至后颅窝静脉系统。通过后椎板切除术在AVF水平上将AVF闭塞。手术后，患者的症状开始减轻。结论：圆锥形髓周围AVF的静脉引流可延伸至颅内静脉，这可能导致混淆临床发现，因为尽管病变位于脊柱内，但症状可能暗示颅内过程。外科医生必须意识到这种令人困惑的表现。

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