neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2020-22-1-56-64neurosurgery-835Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEРадиохирургическое лечение дуральной артериовенозной фистулы из ветвей менингогипофизарных стволов обеих внутренних сонных артерий на аппарате «гамма-нож»Gamma Knife radiosurgical treatment of a dural arteriovenous fistula with the feeding branches from the meningo-pituitary trunks of both internal carotid arterieshttps://orcid.org/0000-0002-8415-5602ТокаревА. С.TokarevA. S.

129090 Москва, Большая Сухаревская пл., 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0002-4534-8719РакВ. А.RakV. A.

129090 Москва, Большая Сухаревская пл., 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0003-1042-0837ГрецкихК. В.GretskikhK. V.

129090 Москва, Большая Сухаревская пл., 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

mail@rssklif.ruhttps://orcid.org/0000-0001-8099-9544ЕвдокимоваО. Л.EvdokimovaO. L.

129090 Москва, Большая Сухаревская пл., 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0002-2221-6641ВиктороваО. А.ViktorovaO. A.

129090 Москва, Большая Сухаревская пл., 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

ГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»РоссияN. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare DepartmentRussian Federation2020110420202215664Copyright © Токарев А.С., Рак В.А., Грецких К.В., Евдокимова О.Л., Викторова О.А., 20202020Токарев А.С., Рак В.А., Грецких К.В., Евдокимова О.Л., Викторова О.А.Tokarev A.S., Rak V.A., Gretskikh K.V., Evdokimova O.L., Viktorova O.A.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/835

Стратегии лечения дуральных артериовенозных фистул (ДАВФ) заключаются в изолированном или комбинированном применении методов микрохирургии, эндоваскулярной трансартериальной или трансвенозной эмболизации и стереотаксической радиохирургии.

В научной литературе описано только 9 случаев двусторонних ДАВФ сосудов головного мозга, которые потребовали хирургического вмешательства, причем у 4 пациентов проведены эндоваскулярные или микрохирургические вмешательства, у 5 – стереотаксическое радиохирургическое лечение, из них у 4 – с предшествующей или последующей эндоваскулярной эмболизацией.

В данной статье представлен случай успешного радиохирургического лечения двусторонней ДАВФ, развившейся из ветвей менингогипофизарных стволов внутренних сонных артерий, с помощью аппарата «гамма-нож» без предшествующей эмболизации или хирургической резекции.

Выполнение стереотаксического радиохирургического вмешательства возможно при низкопоточных ДАВФ, а также как часть комбинированного лечения при высокопоточных ДАВФ. Эффективность этой стратегии требует дальнейшего изучения.

Treatment strategies for dural arterio-venous fistulas (DAFs) include single or multimodal schemes, including microsurgery, endovascular transarterial or transvenous embolization, or stereotactic radiosurgery (SRS).

In the scientific medical resources, only 9 cases of bilateral DAFs of the brain are described, which required surgical intervention, and 4 were treated with endovascular or microsurgical approach; SRS was used in 5 cases, of which in 4 cases with previous or subsequent endovascular embolization.

We have presented a case of successful SRS with Gamma Knife of bilateral DAF from the branches of meningo-hypophyseal trunks from inner carotid arteries without preliminary embolization or surgical resection.

The use of SRS with Gamma Knife is possible with low-flow DAFs, as well as a part of a multimodal strategy with high-flow DAFs, which requires further study.

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