硬脊膜动静脉瘘的诊断和治疗

Diagnosis and treatment of spinal dural arteriovenous fistulas:110 cases report

目的 总结硬脊膜动静脉瘘的诊治经验。 方法 回顾性分析经脊髓MRI和血管造影确诊的 110例硬脊膜动静脉瘘患者的临床及随访资料。 结果 本组患者首选经全椎板切除入路夹闭瘘口至脊髓表面的引流静脉 61例 ,经半椎板切除入路手术 3 7例 ,经血管内栓塞 12例 ,栓塞后复发再手术 3例。患者术后采用了抗凝、血液稀释、早期康复等辅助治疗。 10 6例患者术后复查脊髓血管造影证实瘘口全部闭塞。 89例复查脊髓MRI显示髓周血管流空信号全部消失 ,其中 74例髓内T2高信号消失、15例缩小。术后 98例患者获随访 ,随访时间 3～ 12 0个月 ,5 4例症状完全消失 ,3 4例症状改善 ,10例无变化 ,其中 3例栓塞 1～ 5年后瘘口再通而手术。 结论 硬脊膜动静脉瘘早期诊断、早期治疗 ,预后良好。经单侧半椎板切除入路 。

Objective To discuss the diagnosis, treatment and prognosis of spinal dural arteriovenous fistulas(SDAVF). Methods The clinical and following up date from 110 patients with SDAVF diagnosed by spinal MRI and spinal angiography were analyzed retrospectively. Results Draining vein between fistula and spinal cord was interrupted by laminectomy approach as first choice in 61 patients, by hemilaminectomy approach in 37, and by endovascular embolization in 12, and re operation due to recurrence after embolization in 3. Anticoagulation, hydration and early rehabilitation were used postoperatively. Complete disappearance of SDAVF was confirmed in all 106 patients who received postoperative spinal angiography. The paramedullary tortuous flow voids fully disappeared in 74 patients and partly disappeared in 15 on postoperative T 2 weighted MRI. Follow up of 98 patients showed complete recovery in 54 patients, improvement in 34, and no change in 10. Three of the 10 patients were reoperated on because of recurrence 1 to 5 years after embolization. Conclusions SDAVF can produce good outcome after early diagnosis and treatment. Interruption of the draining vein between fistula and spinal cord by hemilaminalectomy approach is the first choice for the treatment of SDAVF.