硬脊膜动静脉瘘的手术治疗

Surgical treatment of spinal dural arteriovenous fistulas

目的探讨硬脊膜动静脉瘘的诊断及总结手术治疗的经验。方法回顾性分析13例经脊髓血管造影确诊的硬脊膜动静脉瘘患者的临床资料，均行手术夹闭瘘口，其中经全椎板切除入路9例，经半椎板切除入路4例。结果瘘口位于上胸段2例，中胸段3例，下胸段6例，腰段2例。全部病例手术后行脊髓血管造影复查，均未见异常瘘口及迂曲引流静脉。随访2—36个月，13例中症状基本消失、痊愈5例，症状改善、好转7例，无变化1例。结论脊髓血管造影可以准确定位瘘口位置，是诊断硬脊膜动静瘘的金标准。手术夹闭瘘口方法简单，夹闭瘘口确切可靠，效果肯定，可作为硬脊膜动静脉瘘的首选治疗方法。

Objective To discuss the diagnosis and surgical experience of spinal dural arteriovenous fistulas. Methods Thirteen patients with spinal dural arteriovenous fistulas proved by spinal angiography were reviewed. Laminectomy approach was performed in nine cases, and hemilaminectomy approach was performed in four cases. Results The fistulas of 2 cases located in upper thoracic spine, 3 cases in middle thoracic spine, 6 cases in inferior thoracic spine, and 2 cases in lumbar spine. Complete disappearance of spinal dural arteriovenous fistulas was confirmed in all 13 patients who received postoperative spinal angiography. Follow-up of thirteen patients showed completely recovery in 5 cases, improvement in 7 cases, and no change in 1 case after surgery. Conclusion Spinal angiography can demonstrate the fistula location successfully and is a better standard in diagnosis of spinal dural arteriovenous fistulas. Surgical interruption of fistulae is effective in the treatment of spinal dural arteriovenous fistulas, which can be the first choice for spinal dural arteriovenous fistulas treatment.