髓周动静脉瘘的分型和治疗方法的选择

Choice of treatments for varied types of perimedullary arteriovenous fistula

目的 探讨髓周动静脉瘘（ＰＭＡＶＦ）的分型和治疗方法选择的关系。方法 本组５１ 例均行选择性脊髓血管造影检查，并在病变分型后，根据分型选择不同的治疗方法。结果 本组５１ 例分为：ＰＭＡＶＦ１ 型１６ 例：栓塞治疗４ 例，手术１０ 例，栓塞后行手术切除１ 例，未治１ 例；ＰＭＡＶＦ２ 型１９ 例：栓塞治疗６ 例，手术９ 例，栓塞后行手术切除２ 例，未治２ 例；ＰＭＡＶＦ３ 型１６ 例：栓塞治疗１０ 例，手术２ 例，栓塞后行手术切除３ 例，未治１ 例。本组治愈２４ 例，好转１７ 例，无变化３ 例，加重３ 例，未治４ 例，并发症４ 例。结论 ＰＭＡＶＦ是脊髓动静脉畸形（ＳＡＶＭ） 的一种特殊类型。ＰＭＡＶＦ１ 型以手术夹闭瘘口为主；ＰＭＡＶＦ２ 型根据病变血管结构选择不同的治疗方法，手术和栓塞并重；ＰＭＡＶＦ３ 型以栓塞为主，只有少数患者可直接手术。

Objective To discuss the relation between the types of perimedullary arteriovenous fistula (PMAVF) and the choice of treatment. Methods 51 cases were involved in this series. Angiography was performed in all of them.According to the type of the malformation revealed, a choice of treatment was made. Results The 16 cases of PMAVF Type 1 were treated by endovascular embolization (4 cases), surgical clipping (1 case), and endovascular embolization following surgical clipping (1 case); with 1 case untreated. The 19 cases of PMAVF Type 2 were treated by endovascular embolization (6 cases), surgical clipping (9 cases) and endovascular embolization following surgical clipping (2 cases), with 2 cases untreated. The 16 cases of PMAVF Type 3 were treated by endovascular embolization (10 cases), surgical clipping (2 cases) and endovascular embolization following surgical clipping (3 cases), with 1 case untreated. Conclusion PMAVF is a subclass of spinal arteriovenou malformation (SAVM), and can be categorized into 3 classes according to angioarchitecture. PMAVF Type 1 is mainly treatment by surgical clipping; for PMAVF Type 2, surgical clipping and embolization are both at disposal, to be chosen according to the angioarchitecture; Type 3 is mainly treated by embolization, with surgical clipping adopted only in rare occasions.