近端血流阻断加压技术在硬脊膜动静脉畸形血管内治疗中的应用

Application of pressure cooker technique in endovascular therapy of spinal dural arteriovenous fistulae

目的探讨近端血流阻断加压技术在硬脊膜动静脉畸形(SDAVF)血管内治疗中应用的安全性和有效性。方法回顾性分析2017年2月至2018年9月海军军医大学附属长海医院神经外科采用血管内治疗的6例SDAVF患者的临床资料。所有患者术中均应用近端血流阻断加压技术,其中1例因未能完全栓塞,改为显微外科手术治疗。术后即刻行数字减影血管造影(DSA),以判断栓塞情况。对所有患者行门诊或电话随访,随访内容为行Aminoff-Logue评分,判断脊髓功能的恢复情况;门诊随访的患者同时复查脊髓MRI,以判断栓塞情况。结果6例患者的手术均成功。术后即刻DSA显示,5例完全栓塞,1例瘘口残留。所有患者术后均未出现永久性神经系统并发症;其中1例术中造影显示肋间动脉夹层的患者,采用弹簧圈闭塞近端肋间动脉后复查胸椎CT,显示肋间肌内血肿形成,术后持续胸背部疼痛3 d后缓解。6例患者中,5例为门诊随访,1例为电话随访;中位随访时间(范围)为5.5个月(4.0~22.0个月)。术后3个月,6例患者的Aminoff-Logue评分均较术前降低[(2.0±0.7)分、(4.0±1.5)分,P<0.05];脊髓功能得到明显改善。术中因拔管困难而留置体内的1例患者,术后6个月随访时无相关并发症。经显微手术治疗的1例患者出院后10个月行DSA随访,未见瘘口显影。结论初步推测近端血流阻断加压技术在SDAVF血管内治疗中是安全、有效的。

Objective To explore the efficiency and safety of endovascular therapy of spinal dural arteriovenous fistulae(SDAVF)using pressure cooker technique(PCT).Methods Six patients with SDAVF were treated with PCT at Department of Neurosurgery,Changhai Hospital Affiliated to Navy Medical University from February 2017 to September 2018 and retrospectively reviewed in this study.The PCT was applied to embolization in all cases.The reflux did not exceed the plug in 4 cases when Onyx was used for embolization.Microsurgery was performed in 1 case because of incomplete embolization.Digital subtraction angiography(DSA)was performed immediately post operation to assess the embolization.All patients were followed up by outpatient clinic or telephone.Aminoff-Logue score was determined to assess the spinal cord function.Follow-up MRI of the spinal cord was performed to evaluation the embolization.Results All 6 patients underwent successful operations.DSA examination immediately post operation showed that 5 cases had complete embolization and 1 case had residual fistula.No permanent neurological complications occurred in this series.In 1 case,intraoperative angiography showed intercostal artery dissection,and the proximal intercostal artery was occluded with a spring coil.Postoperative CT examination of the thoracic vertebra showed the formation of intra-costal muscle hematoma.The continuous back pain after operation was relieved on the third day.Among the 6 patients,5 were followed up at outpatient clinic and 1 was followed up by telephone.The median follow-up duration was 5.5 months(4.0-22.0 months).At 3 months post surgery,the Aminoff-Logue score of all 6 patients were decreased compared with those before surgery(2.0±0.7 vs.4.0±1.5,P<0.05).Spinal cord function was significantly improved.There was no related complication at 6-month follow-up post operation in 1 patient who had the tube retained due to difficulty in tube withdrawal.One patient underwent microsurgery and DSA at 10-month follow-up post surgery revealed no fistula imaging.Conclusion It has been preliminary suggested that endovascular treatment using PCT seems safe and effective for SDAVF.