脊髓硬脊膜动静脉瘘6例临床分析

Clinical analysis of 6 cases of spinal dural arteriovenous fistula

目的:探讨脊髓硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)的临床特征、影像学特点及治疗,以期提高对SDAVF的早期识别和诊断。方法:对上海市普陀区人民医院神经外科收治住院的6例SDAVF患者临床表现、影像学资料及治疗进行回顾性分析。结果:6例患者中5例为男性,1例为女性,确诊年龄22~74岁,病程2~24个月。累及双下肢肌力5例,累及双下肢或四肢感觉6例,累及大便和(或)小便功能4例,其中2例需留置导尿管。5例患者术前行脊髓磁共振(magnetic resonance,MR)检查,脊髓MR可见脊髓长T1、长T2信号,脊髓表面迂曲血管流空影,增强后可见部分强化。6例患者均行脊髓数字血管造影(digital subtraction angiography,DSA)检查,显示5例瘘口在胸段,1例行3次脊髓血管造影均未见瘘口,手术时发现瘘口。5例患者于手术下行瘘口切除,术后均恢复良好。结论:SDAVF有其临床特征和影像学特点,磁共振检查可作为初筛标准,脊髓血管造影为其诊断金标准。手术为其有效治疗方法,早期诊断、早期治疗有助于改善患者预后。

Objective:To explore the clinical features,imaging features and treatment of spinal dural arteriovenous fistula(SDAVF),in order to improve the early identification and diagnosis of SDAVF.Methods:The clinical features,imaging features and treatment of 6 patients with SDAVF admitted to the Department of Neurosurgery in Shanghai Putuo District People’s Hospital were retrospectively analyzed.Results:Of the 6 patients with SDAVF,5 were males and 1 was female.The age of diagnosis ranged from 22 to 74 years old.The course of the disease ranged from 2 months to 2 years.Legs weakness was involved in 5 patients,legs or limbs sensory disorder in6 patients,and bowel and/or bladder dysfunction in 4 patients,among which 2 patients required indwelling catheter.Magnetic resonance(MR)examination of spinal cord was performed in 5 patients before surgery.The results showed spinal cord long T1 and long T2 signals,and there was vascular flow void signal change on the surface of spinal cord,and enhancement was seen after contrastenhanced MR scan.Digital subtraction angiography(DSA)showed that fistula occurred in the thoracic segment in 5 patients,one patient had 3 times of DSA and no fistulas were found,and the fistula was found during the operation.Fistulas were excised during the surgery in the 5 patients,and all recovered well after the operations.Conclusion:SDAVF has its clinical features and imaging characteristics.Spinal MR can be used for preliminary diagnosis.DSA is the gold standard for diagnosis,surgery is an effective treatment method,and early diagnosis and early treatment can help to improve the prognosis of patients.