硬脊膜动静脉瘘诊断、治疗和预后进展

Recent advances in the diagnosis,treatment and prognosis of spinal dural arteriovenous fistula

硬脊膜动静脉瘘(SDAVF)是一种临床表现多样、误诊率高的罕见疾病。随着无创血管成像技术发展,SDAVF诊断有了一定提高,但脊髓血管造影仍是诊断SDAVF金标准。SDAVF是一种非自限性疾病,一旦发病均需外科手术或血管内栓塞治疗。随着血管内栓塞材料和技术进步,血管内治疗成功率逐渐增高,但外科手术治疗成功率仍数倍于血管内栓塞治疗。尤其是近年外科手术中微创技术发展,使得SDAVF患者获益更大。治疗成功后大部分患者症状可稳定或改善,而未能获早期诊断和治疗常可导致不可逆性神经功能损伤。该文就SDAVF诊断、治疗和预后研究进展作一综述。

Clinically,spinal dural arteriovenous fistula(SDAVF)is a rare disease with various clinical manifestations and high misdiagnosis rate.With the technological development of non-invasive angiography,the diagnostic ability for SDAVF has been certainly improved,although digital subtraction spinal angiography is still the gold standard for the diagnosis of SDAVF.SDAVF is a non-self-limited disease,it requires surgical or endovascular embolization treatment once the disease comes on.With the advances in materials and techniques for endovascular embolization,the success rate of endovascular therapy has gradually increased,but the success rate of surgical treatment is still several times higher than that of endovascular embolization treatment.In recent years,the development of minimally-invasive surgical techniques has greatly benefited patients with SDAVF.In most patients who has achieved a successful treatment the clinical symptoms become stabilized and improved,while in the patients who has not got early diagnosis and treatment the irreversible neurological impairment often occurs.This article aims to make a detailed review about the recent advances in the diagnosis,treatment and prognosis of SDAVF.