脊柱和脊髓血管畸形的诊断和栓塞治疗

Endovascular Embolization of Vascular Malformation in Spine and Spinal Cord

目的：探讨脊柱和脊髓血管畸形的诊断和经血管内的栓塞治疗。材料与方法：根据４０例不同的动静脉瘘、动静脉畸形和血管瘤分别采用聚乙烯醇颗粒、微钨螺旋圈和α氰基丙烯酸正丁酯栓塞病灶。结果：血管畸形消除１００％者２６例，９０％７例，７０％～８０％５例，５０％２例；随访５个月～４年未见明显复发；６７．５％的病例有临床改善。本组主要并发症为栓塞后的继发血栓和蛛网膜下腔出血（１７．５％）。结论：选择与超选择造影和栓塞是基本的技术要求；栓塞术中严防累及脊髓前动脉或Ａｄａｍｋｉｅｗｉｃｚ动脉。若供血动脉细小不便导管操作时，应推荐手术治疗。

Purpose:The embolizing treatment of 40 cases with vascular malformation in spine and spinal cord via endovascular approach are studied here.Materials and Methods:The nidus of malformation were embolized by using different polyvinyl alcohol particles,micro coils and N-butyl cyanoacrylate depending on the characters of arteriovenos fistulae and malformation. Results:our group shows that the 100% of nidus were obliterated in 26 cases,90% in 7 cases,70%～80% in 5 cases and 50%in 2 cases.There were more clinical improvement and no signs of recurrence in 27 cases following up 5 monthes to 4 years. The main complication were secondary thrombosis and subarachnoid hemorrhage(17.5%).Conclusion:Selective and superselective angiography and embolization are the basic technique of endovascular treatment,preserving anterio spinal artery and Adamkiewicz artery should be done during embolization;If the difficult cathetering was met because of the small feeders,the surgical operation would be recommended.