8例硬脊膜动静脉瘘的临床分析

The clinical analysis of spinal dural arteriovenous fistulas(a clinical report of eight cases)

目的:分析硬脊膜动静脉瘘(Spinal dural arteriovenous fistulas,SDAVF)的临床、影像学特点、误诊原因,提高对SDAVF的认识和诊断水平。方法:回顾性分析8例SDAVF患者的临床资料。结果:在本组患者中,下肢运动障碍8例(100.0%)、浅感觉障碍(痛温觉)6例(75.0%)、深感觉异常3例(37.5%)及大小便功能障碍8例(100.0%)。脑脊液检查压力正常2例(40.0%),增高3例(60.0%);蛋白含量正常1例(20.0%),增高4例(80.0%)。脊髓MRI检查示7例(87.5%)有脊髓增粗,8例(100.0%)脊髓前后有迂曲状、"虫蚀样"的血管流空影;5例(62.5%)有脊髓软化坏死信号。全部患者均经脊髓血管造影明确诊断。结论:SDAVF以中老年男性多见,主要表现为进行性加重的运动和感觉功能减退、大小便功能障碍,脑脊液检查无特异性,脊髓MRI可对其进行初步诊断,确诊及瘘口的精确定位有赖于选择性脊髓血管造影。

Objective：To analyze the clinical characteristics,the imaging findings, and the causes of misdiagnosis in order to improve the level of understanding and diagnosis of spinal dural arteriovenous fistulas （SDAVF）. Methods：Eight patients with SDAVF were an- alyzed retrospectively. Results：In these patients＇ legs,there were eight cases （100.0%） with movement disorders, six cases （75.0%） with superficial sensory disttlrbance （pain and temperature sense）, and three cases （37.5%） with deep paresthesia. All patients （ 100. 0% ） have bowel and bladder dysfunction. The cerebrospinal fluid pressure was normal in two cases （40. 0% ） ,increased in three cases （60. 0% ） ;the protein content was normal in one case （20. 0% ） ,increased in four cases （80. 0% ）. MRI examination revealed spinal cord thickening in seven cases （87.5%）,＂ moth-eaten＂ flow void phenomena in the subaraehnoid space in eight cases （100.0%） ,and the signal of spinal cord necrosis in five cases（62.5% ）. Spinal angiography was done in all the patients to verify the diagnosis. Conclusion：This discord is seen in middle-aged men more commonly manifesting progressive motor and sensory function loss through bowel and bladder dysfunction. The cerehrospinal fluid examination is not specific. A MRI is a reliable diagnostic method,but catheter angiography is required to localize the fistula as well as the anglo-architectures, on which the mode of treatment depends.