硬脑膜动静脉瘘形成机制的初步探讨

硬脑膜动静脉瘘形成机制的初步探讨

陈亮;赵曜;毛颖;周良辅

【期刊名称】《中华神经外科杂志》 【年(卷),期】2009(025)002

【摘要】Objective To investigate the pathogenesis of intracranial dural arteriovenous fistula, with a focus on the role of angiogenic factors and chronic brain hypoperfusion in it. Methods 120 Sprague-Dawley rats were randomly divided into 4 groups: 1) Group A (n=25) , sham operation; 2) Group B (n = 25), thrombosis of the sagittal sinus; 3) Group C (n = 35), anastomosis of the right common carotid artery(CCA) to the external jugular vein(EJV) and occlusion of the proximate-cardiac end of the transverse sinus on the left; 4) Group D(n =35) , procedures done as Group C and thrombosis of the sagittal sinus was added. Mean arterial pressure, sinus pressure, blood flow of the brain were monitored during the operation and again tested 1, 2, 4, 12 weeks after operation in subgroups of animals, respectively. Histological examination was used to test the distribution and concentration of VEGF and MMP-9 in dura mater, arachnoid membrane, cortex and basal ganglia. Perfusion MRI of the brain was done to compare blood flow in different site of the brain. Results In group C and D, the mean blood pressure decreased soon after operation, and the sinus pressure elevated to (28.55±4. 92) mm Hg and kept stable at (22. 34 ±3.24) mm Hg 4 weeks later. The blood flow

of the brain went down significantly after operation in group C and D, with markedly reduction in the right occipital lobe versus any of the other sites. Two weeks later the blood flow had returned to the normal level in the left side but remained abnormal in the right occipital lobe. Perfusion MRI found higher blood volume and longer mean time to enhance in the right occipital lobe, than in its contralateral side. Immunohistological stain of VEGF was positive in basal ganglia, right occipital lobe and arachnoid membrane one week after operation, but weakened in basal ganglia two weeks later. VEGF expression was weak in dura mater one week after operation, but became strongly positive from the 4th to 12th week after operation. The angiogenesis was prominent in the dura mater 12 weeks after operation in group C and D but negative or obscure in group A and B. Conclusions High sinus pressure was critical for angiogenesis of dura mater. Chronic brain hypoperfusion, which will elevate the expression of VEGF and MMP-9, is an important step from the progression of venous sinus pertension to DAVF formation.%目的 探讨硬脑膜动静脉瘘(DAVF)发病机制.方法 将大鼠右侧颈总动脉的近心端与颈外静脉的远心端端端吻合并结扎对侧横窦导致颅内静脉高压,随访12周,监测静脉窦压力、脑血流和血管内皮生长因子(VEGF)在基底节、皮层、蛛网膜和硬膜的分布.结果 术后出现皮层血流的显著性下降,右侧枕叶最明显并持续至实验结束.基底节区VEGF表达在术后1周即达高峰,在2周后转为阴性或弱阳性,枕叶皮层和蛛网膜血管呈持续阳性表达.枕部矢状窦及周围

硬膜在术后早期呈弱阳性,在4周至12周呈持续阳性表达.术后12周硬膜微血管明显增加,管腔扩张.结论 DAVF形成的关键在于静脉窦压力升高,脑慢性低灌注是从静脉窦高压到硬膜血管增生过程中的重要一环. 【总页数】4页(124-127)

【关键词】硬脑膜动静脉瘘;模型;大鼠 【作者】陈亮;赵曜;毛颖;周良辅

【作者单位】200040,上海,复旦大学附属华山医院神经外科,复旦大学上海医学院神经外科学系;200040,上海,复旦大学附属华山医院神经外科,复旦大学上海医学院神经外科学系;200040,上海,复旦大学附属华山医院神经外科,复旦大学上海医学院神经外科学系;200040,上海,复旦大学附属华山医院神经外科,复旦大学上海医学院神经外科学系 【正文语种】中文 【中图分类】R74 【文献来源】

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