硬脊膜内背侧动静脉瘘的显微外科治疗

目的 探讨硬脊膜内背侧动静脉瘘的显微外科治疗及其疗效,初步探索术中吲哚菁绿荧光血管造影的应用.方法 2004年1月至2008年8月共有24例硬脊膜内背侧动静脉瘘患者进行了半椎板切除显微外科治疗并获得随访.其中2例为先接受介入栓塞治疗,后因复发再接受外科手术治疗.3例接受术中吲哚菁绿荧光血管造影.脊髓功能评价采用改良阿米诺夫量表,结合影像学检查结果对术后疗效进行综合评价.结果 术后平均随访36个月,影像学随访未见病变残留或复发.脊髓功能评价16例为优,阿米诺夫评分平均0.7分;4例为良,平均4.8分;3例为中,平均6.7分;1例为差,平均9.0分.综合疗效评价,治愈16例,改善6例,无变化2例.结论 单侧半椎板切除入路显微外科治疗足对硬脊膜内背侧动静脉瘘的有效治疗方法,术中吲哚菁绿荧光血管造影有助于手术.

Microsurgical treatment of intradural dorsal arteriovenous fistulas

Objectives To evaluate efficacy of microsurgical hemilaminectomy approach and use of intraoperative indocyanine green videoangiography for patients with intradural dorsal arteriovenous fistula.Methods Medical records and follow-up data of 24 patients who were microsurgically treated at a single institution for intradural dorsal arteriovenous fistula between January 2004 and August 2008 were retrospectively reviewed.Preoperatively DSA was performed for definite diagnosis.All patients were evaluated with the Aminoff and Logue scale.Preoperative,4 patients had excellent spinal condition having mean score of 1.0;8 cases had good spinal condition with mean score of 3.4;9 cases had average spinal condition with mean score of 6.9;3 cases had poor spinal condition with mean score of 10.0.Twenty two cases had one feeder while 2 cases had two feeding arteries.All the patients underwent microsurgical hemilaminectomy via a posterior approach.Two patients received complemented surgery because of the recurrence of the lesion after embolisation failed.Three patients received intraoperative indocyanine green videoangiography.Combined followed-up imaging and myelonic function were used for evaluating followed-up data.Results Mean follow up was done up to 36 months.Followed-up imaging didn't reveal any residual lesion or its recurrence.Spinal functional assessment using Aminoff and Logue scale showed 16 patients of excellent outcome and had mean score of 0.7:4 had good outcome having mean score of 4.8;3 was of average nature with mean score of 6.7;1 had poor outcome with 9.0 scores.With the surgical treatment,16cases were cured,6 were improved and 2 cases had no change according to synthetic curative effect.Conclusions Microsurgical treatment,especially the microsurgical hemilaminectomy via a posterior approach,is effective treatment intradural dorsal arteriovenous fistula.Intraoperative indocyanine green videoangiography is a simple auxillary tool for intraoperative quality control and favorable surgical outcomes.