硬脑膜动静脉瘘向脊髓表面引流1例并文献复习

Intracranial duralarteriovenous fistulas with spinal perimedullary venous drainage: case report and literature review

目的探讨硬脑膜动静脉瘘向脊髓引流的临床特点、影像学表现和诊疗方法。方法回顾性分析1例硬脑膜动静脉瘘向脊髓引流患者,以及检索1996~2015年国内外文献报道的相关病例的临床资料。结果本例患者予以介入栓塞治疗后症状好转。检索文献获取临床资料完整的患者共47例,其中手术治疗者17例,介入治疗者25例。结论硬脑膜动静脉瘘向脊髓引流为一种少见的血管畸形,脊髓损害的症状明显。诊断的金标准是完整的脑血管造影检查。最佳治疗方法尚有争议,主要包括介入栓塞治疗和手术夹闭瘘口。

Objective To explore the clinical manifestations,diagnosis,and treatments of intracranial duralarteriovenous fistulas（ IDAVF） with spinal perimedullary venous drainage（ Cognard type Ⅴ）. Methods The clinical data of one patient with Cognard type Ⅴ IDAVF were analyzed retrospectively. We systematically reviewed thepublished clinical data of Cognard type Ⅴ IDAVF and discussed the clinical characteristics,imaging features,treatments and prognosis. Results After embolization,the angiography showedobliteration of the fistula and disappearance of the spinalperimedullary venous drainage. We systematically reviewed 47 complete published Cognard type Ⅴ IDAVF. 17 patients received surgical approach and 25 patients undergone embolization.Conclusion Cognard type Ⅴ IDAVF is an uncommon presentation and is usually challenging because the presentingsymptoms are variable and often related tospinal dysfunction. Complete cerebral angiography is the gold standard of diagnosis. The optimal management strategy for TDAVF is still controversial,which includes surgical approach and embolization.