颈髓动静脉畸形的临床和影像诊断

Characteristics of Clinio-Imaging of Cervical Spinal Cord Arteriovenous Malformation

文中报道７例经选择性脊髓动脉造影或／和ＭＲＩ证实的颈髓动静脉畸形（ＣＳＡＶＭ），着重分析其临床和影像特点。其中２例行手术治疗，１例经血管内栓塞。４例突发起病，临床症状和体征以及脑脊液检查诊断蛛网膜下腔出血（ＳＡＨ），脑ＣＴ和颈动脉造影正常。４例病变位于髓内，３例以髓外为主，髓内也受累。５例行ＭＲＩ检查均明确显示病变的部位和范围，１例可见异常血管团内的慢性出血灶以及位于颈髓背侧呈锯齿状向头侧引流的静脉。ＭＲＩ检查可作为ＣＳＡＶＭ确诊的方法，但对拟行手术和血管栓塞治疗的患者行选择性脊髓动脉造影是必要的。上颈段动静脉畸形主要由颅内段椎动脉分支供血，血管栓塞和手术治疗较下颈段困难和危险。

Seven patients with cervical spinal cord arteriovenous malformation(CSAVM),confirmed by selective spinal angiography or/and MRI.were reviewed,operation and embolization done in two and one respectively.The sudden onset of neurologic symptoms and signs suggestive of the intracranial SAH was the major clinical feature in four patients with normal cerebral CT scans and carotid angiography,Four patients were of intramedullary AVM's and three affected both intra and extra with prominently extramedullary lesions.Five patients with MRI definitly revealed the lesion, and chronic hemorrhage within the nidus and enlarged draining veins intracranially indenting the posterior cord were seen in one of them.The upper CSAVM was supplied mainly by anterior as well as posterior spinal arteries from vertebral artery in three patients,and the embolization in these patients is very difficult and high risk.However,the embolization of the radiculomedullary arteries,particularly the posterior,which serve as main feeding arteries of CSAVM,is relativelv safe.