硬脊膜动静脉瘘(附1例临床分析)

目的探讨硬脊膜动静脉瘘(SDAVF)的病因、发病机制、临床表现、诊断及治疗。方法回顾性分析了1例患者的相关临床资料。结果本例患者以双下肢渐进性麻木、无力1年余,加重伴大小便障碍9个月为主要临床表现,脊髓MRI显示T9~L1髓内以长T2长T1为主之异常信号,超选择DSA造影可见位于入LT12椎管处一硬脊膜动静脉之瘘口,成功地进行了经单侧椎板开窗夹闭瘘口术。结论SDAVF为一具有直接的动静脉交通性病变,常伴有小型畸形团,多发生于中年男性,误诊率高,主要表现为渐进性的肢体麻木、无力及大小便障碍,MRI有助于诊断,但仍须DSA确诊。阻断连接瘘口与冠状静脉丛的引流静脉是治疗SDAVF的有效方法,显微外科手术效果可靠、复发率低,尽早地确诊和治疗是取得良好疗效的根本前提。

Spinal dural arteriovenous fistulas(report of 1 case)

Objective To discuss the etiology,pathogenesis,clinical manifestation,diagnosis and therapy of spinal dural arteriovenous fistulas (SDAVF).Methods The clinical data of the patient including spinal MRI and selective spinal angiography were analyzed retrospectively.Results The author reported a 36-year-old man presenting with progressive weakness in legs and ascending sensory deficits below the waist over one year time span and urination and defecation disturbance of 9 months duration was performed.Increased T_2 signal and slight swelling T_1 signal within T9-L1 spinal cord were found.Selective spinal angiography revealed a SDAVF on the left T12 nerve root sheath.The fistula was successfully treated by microsurgical interruption of the draining vein between fistula and spinal cord by hemilaminalectomy approach.Conclusion SDAVF are vascular anomalies composed of intertwining arteries and veins with direct arteriovenous communication.SDAVF are often seen in meddle-aged males and its misdiagnosis rate is high.Symptoms include progressive paresis,ascending sensory deficits and loss of control over bladder and bowel function that commonly take place over a 2- to 3-year time span.MRI may facilitate diagnostic procedure,however,selective spinal angiography is still required to confirm diagnosis.Treatment is aimed at elimination of arterialized radicular-medullary draining vein of SDAVF.Microsurgical shunt interruption has proven secure and reliable.SDAVF should be treated as early as possible after diagnosis and can produce good outcome.