术中脊髓血管造影辅助下精准治疗脊髓硬脊膜动静脉瘘二例并文献复习

Microsurgical accurately treated spinal dural arteriovenous fistulas with intraoperative spinal digital subtraction: report of 2 cases and review of the literatures

回顾性分析2例在复合手术室手术治疗的脊髓硬脊膜动静脉瘘(SDAVF)患者的临床资料,并进行文献回顾,以探讨术中脊髓血管造影结合图像融合技术在SDAVF手术中的应用价值。2例术前经脊髓血管造影证实为SDAVF,瘘口位于胸段,于复合手术室内进行动静脉瘘切除术,并采用改良Aminoff-Logue量表评价脊髓功能。2例患者术中均准确地找到瘘口并将其切断,即刻脊髓血管造影显示瘘口均完全消失。术中脊髓造影、图像融合及定位时间分别为70、60 min,均未发生造影相关并发症。术后随访12～14个月,2例患者症状较术前有不同程度好转,改良Aminoff-Logue量表评分分别下降6、5分。提示术中行脊髓DSA结合影像融合技术,能精准判断硬脊膜动静脉瘘的静脉端位置,减轻手术创伤,确保瘘口全部闭塞。

The medical records of 2 cases of spinal dural arteriovenous fistula(SDAVF)treated in the hybrid operating room were analyzed retrospectively and the relevant literatures were reviewed to evaluate the clinical value of intraoperative spinal digital subtraction angiography(SDSA)combined with image fusion technology.Both cases were diagnosed by spinal angiograms before operation.Both fistulas were accurately found at thoracic level and surgically disconnected in the hybrid operating room.The modified Aminoff-Logue scores(mALS)was used to evaluate the spinal function.Intraoperative SDSAs were performed immediately after disconnections,and the fistulas were showed to be completely disappeared.The duration of intraoperative SDSAs and Image fusion for fistula localization were 70 and 60 minutes respectively.No SDSA-related complications happened.The clinical symptoms of both patients improved variously during 12-14 months of follow-up.The decreasing of mALS were 6 and 5 points respectively.Our experience indicated that intraoperative SDSA combining image fusion technology was helpful for precisely localizing the fistulas of SDAVF,making their surgeries less invasive and the surgical disconnections more reliable.