经半-半椎板入路治疗硬脊膜动静脉瘘14例

Experience of 14 cases using hemi-semilaminectomy microsurgery treating by spinal dural arteriovenous fistula

目的 探讨经半-半椎板显微手术治疗硬脊膜动静脉瘘(SDAVF)的有效性及可行性。 方法 回顾性分析了2006至2014年就诊于浙江大学医学院附属第二医院神经外科的32例硬脊膜动静脉瘘患者的临床资料。患者于术前行MRI检查及血管造影确诊,其中研究组14例,经半-半椎板入路手术治疗,对照组18例经传统全椎板入路手术治疗。 结果 硬脊膜动静脉瘘瘘口位于胸段18例,腰段12例,颈段2例。瘘口均为单动脉供血。经半-半椎板入路显微手术夹闭瘘口与传统手术相比在未增加并发症的前提下,手术时间短、出血量少,患者住院时间及费用少。随访6个月至2年,患者术后症状均较前术前好转。 结论 在术前行脊髓血管造影精确定位瘘口位置的前提下,经半-半椎板入路显微手术夹闭瘘口安全可行,且手术创伤更小,有利于脊柱稳定性的保持。

Objective To explore the efficacy and feasibility of the hemi-semilaminectomy microsurgical operation treatment of spinal dural arteriovenous fistula (SDAVF). Methods The clinical data of 32 patients with SDAVF were analyzed retrospectively. Before operation all patients were diagnosed by spinal MRI and spinal angiography, 14 patients were treated by hemi-semilaminectomy approach and other 18 patients were by traditional laminectomy approach. All the data were analyzed by T test and P<0.05 was considered to have significant difference. Results The nidus of SDAVF located on thoracic segments in 18 cases, lumbar segments in 12 cases, and cervical segment in 2 cases, which was fed by single artery. The hemi-semilaminectomy microsurgical operation showed shorter operation time, less bleeding, less hospitalization time and cost. All the patients followed-up for 6 months-2 years. Symptoms of all the patients were improved compared with those before surgery. Conclusions On the premise of spinal angiography accurately positioning the location of fistula, the hemi-semi-laminectomy approach microsurgery clipping operation is safe and feasible, and the operation has fewer traumas, also helps to maintain the stability of spine.