neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.24412/2587-7569-2025-1-91-98neurosurgery-1654Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEРазрыв этмоидальной дуральной артериовенозной фистулы – показание к экстренной операции (клинические наблюдения)Rupture of ethmoidal dural arteriovenous fistula – indication for emergency surgery (clinical cases)https://orcid.org/0000-0002-5743-8279СенькоИ. В.SenkoI. V.

117997 Москва, ул. Островитянова, 1, стр. 10

Bld. 10, 1 Ostrovityanova St., Moscow 117513

https://orcid.org/0000-0002-5009-3669РыжковаЕ. С.RyzhkovaE. S.

Елена Станиславовна Рыжкова

115446 Москва, Коломенский проезд, 4

Elena S. Ryzhkova.

4 Kolomenskiy Proezd, 115446 Moscow

rizhckowa.elena@yandex.comhttps://orcid.org/0000-0001-7060-0667МельченкоС. А.MelchenkoS. A.

117997 Москва, ул. Островитянова, 1, стр. 10

Bld. 10, 1 Ostrovityanova St., Moscow 117513

https://orcid.org/0000-0002-1320-5772ГригорьевИ. В.GrigorievI. V.

117997 Москва, ул. Островитянова, 1, стр. 10

Bld. 10, 1 Ostrovityanova St., Moscow 117513

https://orcid.org/0000-0002-7081-3766ХовринД. В.KhovrinD. V.

115446 Москва, Коломенский проезд, 4

4 Kolomenskiy Proezd, 115446 Moscow

ФГБУ «Федеральный центр мозга и нейротехнологий» Федерального медико-биологического агентства РоссииРоссияFederal Center for Brain and Neurotechnologies, Federal Medical and Biological Agency of RussiaRussian FederationГБУЗ «Городская клиническая больница им. С. С. Юдина Департамента здравоохранения г. Москвы»РоссияS.S. Yudin City Clinical Hospital, Moscow Healthcare DepartmentRussian Federation2025190420252719198Copyright © Сенько И.В., Рыжкова Е.С., Мельченко С.А., Григорьев И.В., Ховрин Д.В., 20252025Сенько И.В., Рыжкова Е.С., Мельченко С.А., Григорьев И.В., Ховрин Д.В.Senko I.V., Ryzhkova E.S., Melchenko S.A., Grigoriev I.V., Khovrin D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1654

Цель работы – продемонстрировать варианты хирургического лечения этмоидальных дуральных артериовенозных фистул (ЭДАВФ), с учетом данных литературы предложить возможный алгоритм лечения при разорвавшихся и неразорвавшихся ЭДАВФ.

В статье представлены 4 клинических наблюдения пациентов с ЭДАВФ. Во всех случаях артериальное кровоснабжение ЭДАВФ осуществлялось решетчатыми ветвями глазной артерии. В 3 наблюдениях ЭДАВФ сопровождались разрывом с формированием внутримозговой гематомы, в 1 наблюдении ЭДАВФ была без разрыва. Трем пациентам выполнено открытое хирургическое вмешательство, одному – трансвенозная эмболизация ЭДАВФ. У 3 пациентов в послеоперационном периоде подтверждено полное выключение ЭДАВФ без развития осложнений, 1 пациент скончался от последствий кровоизлияния.

Пациентам с разрывом ЭДАВФ необходимо незамедлительное проведение хирургического вмешательства ввиду крайне высокого риска повторного разрыва. Основными методами лечения ЭДАВФ являются открытое хирургическое вмешательство или эндоваскулярная эмболизация. Пациентов с ЭДАВФ без разрыва предпочтительно направлять в федеральные нейрохирургические центры для проведения эндоваскулярного лечения.

Objective of this paper is to demonstrate the variants of surgical treatment of ethmoidal dural arteriovenous fistulas (eDAVFs), propose a treatment algorithm for ruptured and unruptured eDAVFs taking into account the literature data. This article presents 4 clinical cases of patients with eDAVFs. The arterial supply of eDAVF was performed by the ethmoidal branches of the ophthalmic artery in all cases. There were 3 ruptured eDAVF with formation of intracranial hematoma and one unruptured eDAVF. Three patients underwent open surgical intervention, one – transvenous eDAVF embolization. Complete exclusion of eDAVF without complications in the postoperative period was confirmed in 3 patients, 1 patient died because of consequences of hemorrhage.

Patients with eDAVF rupture required immediate surgical intervention due to extremely high risk of repeat rupture. The main techniques of eDAVF treatment are open surgical intervention and endovascular embolization. Patients with unruptured eDAVF should be referred to Federal neurosurgical centers for endovascular treatment.

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The authors declare that there are no conflicts of interest present.