硬脊膜动静脉瘘的血管造影诊断与栓塞治疗

Angiographic diagnosis and embolization treatment for spinal dural arteriovenous fistulae

目的 探讨硬脊膜动静脉瘘的血管造影诊断与栓塞治疗价值。方法 回顾性分析 2 8例硬脊膜动静脉瘘的选择性血管造影与栓塞治疗资料 ,所有患者均行全脊髓动脉血管造影检查。结果 2 8例硬脊膜动静脉瘘经血管造影检查均能明确诊断 ,能显示病变的范围、血供情况及其特征 ,其特点为硬脊膜动脉与脊髓表面静脉直接相通。 18例 (占64 .3 % )硬脊膜动静脉瘘位于脊柱左侧 ,10例 (占 3 5 .7% )位于右侧 ;2 3例瘘口 (占 82 .1% )位于胸 3与腰 2椎体平面之间。经超选择插管后 17例患者接受了栓塞治疗 ,其中 12例行栓塞后手术切除。随访观察见患者临床症状改善者 11例(占 64 .7% ) ,病情稳定者 4例 (占 2 3 .5 % ) ,病情加重者 2例 (占 11.8% )。所有栓塞病例均无严重并发症发生。结论 经选择性血管造影明确诊断后行栓塞治疗是硬脊膜动静脉瘘安全而较为有效的治疗手段。

Objective To explore the value of angiographic diagnosis and the embolization of spinal dural arteriovenous fistulae(SDAVF).Methods Twenty eight patients with SDAVF who underwent selective angiography and embolization were analyzed retrospectively.Using Seldinger technique,angiography of each pair of intercostals,lumbar arteries,bilateral vertebral arteries,bilateral thyrocervical and costocervical trunks was performed.Results In the 28 patients who underwent selective angiography of SDAVF,the extent of lesion,the amount of vascularity and the nature of the feeding vessels were defined.The angiographic features were: spinal dural artery shunted with the superficial veins of spinal cord.The SDAVFs were found twice as often as the left side,compared with the right.A total of 82.1% of the SDAVFs were located between T3 and L2.By superselective catheterization,17 cases were embolized,including resection after embolization in 12 cases.After treatment,the conditions of 11 patients (64.7%) showed improvement, 4 patients (23.5%) showed no change (without further deterioration),and two patients deteriorated.There were no severe complications during embolization.Conclusion Transcatheter embolization is an effective and safe therapeutic method for SDAVF when angiography and superselective catheterization are perfectly done.