显微手术处理硬脊膜动静脉瘘

目的探讨显微手术处理硬脊膜动静脉瘘的方法和疗效的评价。方法回顾性分析12例经脊髓血管造影确诊的硬脊膜动静脉瘘患者的临床资料,根据计划手术节段前X线定位,采用后正中入路切除半侧椎板,切开硬脊膜,显微镜下探查硬脊膜动静脉瘘口,在硬脊膜内灼闭血管瘘口并剪断,缝合硬脊膜。结果11例术后症状改善,其中运动功能改善最明显,感觉障碍改善次之,1例无改善。无手术并发症,无复发。结论显微手术治疗硬脊膜动静脉瘘创伤小、方法简单、效果肯定,可作为硬脊膜动静脉瘘的首选治疗方法。     

硬脊膜动静脉瘘的诊断与手术治疗

目的:探讨硬脊膜动静脉瘘的诊断与手术治疗方法.方法:回顾性分析39 例硬脊膜动静脉瘘患者的临床资料、治疗方式及术后转归.结果:39例患者脊髓MRI和选择性脊髓血管造影确诊,均行显微手术治疗.术后行脊髓血管造影复查,显示瘘口全部消失.29例患者术后6个月行脊髓MR复查,显示脊髓周围的血管流空影完全消失,T2 像髓内高信号影消失或明显减少.39例患者获随访,随访时间3～18个月,37例症状改善,2例无变化,未见复发.结论:脊髓MRI和选择性血管造影是确诊硬脊膜动静脉瘘的方法,显微手术治疗疗效确切.     

神经内镜辅助手术治疗硬脊膜动静脉瘘

目的 探讨神经内镜辅助手术治疗硬脊膜动静脉瘘的手术方法.方法 回顾性分析山东大学齐鲁医院2008年11月至2010年11月采用半椎板入路神经内镜辅助手术治疗硬脊膜动静脉瘘8例患者的临床表现、影像学资料、手术方法、术后恢复及随访资料.结果 8例患者均为单瘘口病变,术中神经内镜辅助下发现瘘口并行引流静脉切断术,术后复查造影所有病例均影像学治愈;随访3～35个月,平均11.2个月,2例症状完全消失,5例明显好转,1例无变化.结论 神经内镜辅助手术治疗硬脊膜动静脉瘘微创、安全、有效.

Abstract：

Objective To study the utility of neuroendoscope-assisted surgery in the treatment of spinal dural arteriovenous fistulas.Methods From November 2008 to November 2010,8 cages of spinal dural arteriovenous fistulas underwent neuroendoscope-assisted surgical treatment by a hemilaminectomy approach.Retrospective analyses were performed for their clinical manifestations,imaging findings,surgical approaches,postoperative recovery and follow-up profiles.Results All were of single fisula.Under the assistance of neuroendoscope,the fistulas were found intra-operatively and the draining veins disconnected successfully.The results of post-operative angiography showed the disappearance of all draining veins.After a follow-up period of 3-35 months,2 cases became asymptomatic,5 cases improved obviously and 1 case had no change.Conclusion Neuroendoscope-assisted surgery is mini-invasive,safe and effective in the treatment of spinal dural arteriovenous fistulas.     

硬脊膜动静脉瘘的诊断与治疗

目的分析硬脊膜动静脉瘘的临床及影像学特点、手术效果,提高对SDAVF的认识和诊断水平。方法回顾性分析2013年1月至2018年12月我科收治的20例SDAVF患者的临床资料,所有患者术前均行脊髓血管造影以明确诊断,手术采用全椎板或半椎板入路,脊髓功能的评估采用改良Aminoff-Logue评分系统,结合影像学检查结果对术后疗效进行综合评价。结果 20例患者入院临床表现为下肢不同程度的下肢无力或瘫痪20例(100%);肢体麻木或感觉迟钝16例(80%);大小便功能障碍16例(80%);腰背部疼痛8例(40%)。脊髓血管造影确定瘘口位置:上胸段及中胸段(T1～T8) 6例;下胸段(T9～T12) 10例;腰段4例,无骶段SDAVF患者。所有患者术中均成功找到瘘口并切除。术后随访3～72个月(平均36个月),术后症状改善16例(80%),稳定3例(15%),1例症状加重(5%);术后影像学随访未见病变残留或复发。结论 SDAVF是少见的脊髓血管畸形,早期诊断及治疗能阻止病变的进展,显著提高患者的预后。     

脊髓硬脊膜动静脉瘘7例诊治分析

目的探讨脊髓硬脊膜动静脉瘘(SDAVF)的诊断及治疗方法。方法脊髓硬脊膜动静脉瘘7例,分析其临床特点、脊柱MR影像特征,并用脊髓血管造影明确诊断。7例均采用半椎板切除闭塞瘘口手术治疗,手术前后采用改良Amilnoff-Logue评分进行评价,并复查脊柱MR,术后随访3～17个月。结果 7例复查脊柱MR不规则血管流空信号均减少,T2像高信号消失。Amilnoff-Logue评分改善6例,无变化1例。结论 SDAVF临床表现不具有特异性,但脊柱MR可见脊髓表面有广泛迂曲扩张的血管流空信号,脊髓血管造影可以确诊,显微神经外科手术简单有效。     

特殊影像表现的硬脊膜动静脉瘘

目的增强临床医师对影像不典型硬脊膜动静脉瘘（SDAVF）的认识，并加深对脊髓血管畸形的理解。方法回顾分析2例SDAVF患者的临床与影像学特征及手术治疗情况。结果2例患者的临床表现与典型的SDAVF差异不大，患者均行手术治疗并术后复查脊髓造影，显示瘘口及引流静脉全部消失，患者术后临床症状全部改善。结论脊髓血管畸形的准确诊断有赖于全面的脊髓血管造影；影像学的发展尤其是磁共振技术的发展对诊断和鉴别诊断脊髓血管畸形提供了有力帮助；在正确诊断的基础上选择适合的治疗方法，才能得到最佳治疗效果。     

硬脊膜动静脉瘘的MRI和DSA诊断价值

目的 评价MRI对硬脊膜动静脉瘘(SDAVF)的诊断价值.方法 分析我院近年来2例SDAVF病例,全部行MRI检查及DSA证实.结果 胸段2例,均呈长T1WI长T2WI信号,病灶沿脊髓长轴走形,呈蚯蚓状,团状改变,可见异常血管流空信号改变,相应脊髓稍有受压1例,脊髓稍有增粗1例.结论 DSA显示SDAVF瘘口部位、供血血管以及引流静脉情况,是SDAVF确诊的金标准.MRI是SDAVF主要的筛选检查,对早期诊断有着重要的临床意义.     

硬脊膜动静脉瘘个体化综合治疗效果观察

目的 探讨硬脊膜动静脉瘘的个体化治疗方法.方法 对41例磁共振影像和选择性脊髓血管造影确诊的硬脊膜动静脉瘘患者,根据临床诊断和病变节段的X线定位,分别采取血管内栓塞瘘口或半椎板开窗显微手术夹闭瘘口和引流静脉.术后进行个体化综合治疗,血管内栓塞瘘口者抗凝治疗;手术夹闭瘘口及引流静脉者针对影像学有无脊髓病变,早期开始综合治疗消除脊髓水肿,配合康复疗法恢复脊髓功能.结果 41例术后运动功能恢复和好转者占92.7％(38/41),无好转者占7.3％(3/41);感觉障碍恢复或好转者占95.1％(39/41).随访3～24个月,全部病例症状无复发,无手术并发症.结论 硬脊膜动静脉瘘的个体化治疗应当包括手术和手术后综合治疗两部分,个体化治疗有助于提高临床疗效.     

硬脊膜动静脉瘘1例误诊分析

硬脊膜动静脉瘘(SDAVF)是脊髓血管畸形中最常见的一种类型,是指供应硬脊膜或神经根的细小动脉在椎间孔处穿过硬脊膜时与脊髓引流静脉异常交通,引起椎管内脊髓静脉高压,脊髓瘀血水肿,继而变性坏死,引起患者进行性脊髓功能障碍[1]。由于该病早期症状和体症缺乏特异性,易与其它脊髓病变相混淆引起误诊。我科2009年4月收治入院前误诊的SDAVF患者1例,现报告如下。1病例报告患者男性,42岁。因双侧下肢麻木伴乏力1年就诊,主要表现为双下肢麻木、束带感,间歇性跛行,长距离行走后双下肢乏力,伴有小便和性功能障碍。1年前在当地医院检查诊断为颈椎管狭窄行C4~C6椎管减压术。术后感双侧下肢麻木、乏力症状加重,间     

Onyx胶栓塞治疗2例硬脊膜动静脉瘘

硬脊膜动静脉瘘(Spinal dural arteriovenous fis-tulas,SDAVF)是硬脊膜的动静脉之间存在微小的瘘口,发病率较低,临床少见,但占脊髓血管畸形的80%,好发于中老年男性,进行性加重,最终可造成患者不可逆的神经功能障碍.自2005年,我科共收治2例患者,经栓塞治疗,效果良好,现报告如下.     

硬脊膜动静脉瘘临床特点分析

目的 总结硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)的临床特点.方法 选取2014年9月至2019年9月首都医科大学宣武医院神经内科收治的接受腰椎穿刺检查的28例SDAVF患者.结果 患者中男27例,女1例.发病年龄41.0～78.0岁,平均55.5岁.临床症状多...     

Acute paraplegia following embolization of spinal dural arteriovenous fistula

Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

     

脊髓硬脊膜动静脉瘘6例临床分析

目的:探讨脊髓硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)的临床特征、影像学特点及治疗,以期提高对SDAVF的早期识别和诊断.方法:对上海市普陀区人民医院神经外科收治住院的6例SDAVF患者临床表现、影像学资料及治疗进行回顾性分析.结果:6例患者中5例为男性,1例为...     

自动触发椭圆形中心编码对比增强磁共振血管成像技术在脊髓硬膜动静脉瘘中的初步应用

目的初步探讨自动触发椭圆形中心编码对比增强磁共振血管成像(MRA)技术在脊髓硬膜动静脉瘘(SDAVF)中的应用价值。方法对5例疑为胸腰段的SDAVF患者行椭圆形中心编码的增强MRA检查,均经选择性脊椎动脉造影和手术证实。结果自动触发椭圆形中心编码的增强MRA显示,5例SDAVF患者的瘘口水平和引流静脉的方向均与数字减影血管造影检查和手术结果相符。MRA检查对于瘘口的定位和引流静脉引流方向的诊断准确率达100%。结论在脊髓血管造影前,椭圆形中心编码的增强MRA检查可以帮助诊断SDAVF,并能初步明确其瘘口水平。     

显微外科手术与血管内栓塞治疗硬脊膜动静脉瘘临床疗效比较的meta分析

目的: 通过meta分析比较显微外科手术与血管内栓塞治疗硬脊膜动静脉瘘的临床疗效。方法: 计算机检索PubMed、Embase、Web of Science、Cochrane临床试验数据库、中国知网、万方数据库、中国生物医学文献数据库(Chinese BioMedical Literature Database,CBM),检索时间从数据库建库至2019年12月,纳入采用显微外科手术和血管内栓塞治疗硬脊膜动静脉瘘的所有中英文文献。使用RevMan 5.3软件进行统计学分析,评估术后早期失败率、远期复发、神经功能恢复程度、并发症情况,比较两种治疗方式对硬脊膜动静脉瘘的临床疗效,并对血管内栓塞治疗进行亚组分析。结果: 纳入文献46篇,共1 958例硬脊膜动静脉瘘患者,其中935例采用显微外科手术治疗,1 023例采用血管内栓塞治疗,漏斗图显示未见明显发表偏倚。经meta分析结果显示,显微外科手术早期治疗失败的发生率低于血管内栓塞治疗(OR=0.20, 95%CI: 0.13~0.30, P<0.05),远期复发率也低于血管内栓塞治疗(OR=0.36, 95%CI: 0.22~0.58, P<0.05),显微外科手术治疗后患者神经功能改善情况优于血管内栓塞治疗的患者(OR=2.86, 95%CI: 1.36~5.99, P<0.05),两种治疗方式患者并发症的发生率差异无统计学意义(OR=1.52, 95%CI: 0.88~2.64, P=0.14)。血管内栓塞治疗的患者中,使用Onyx胶进行栓塞比使用α-氰基丙烯酸正丁酯(n-butyl 2-cyanoacrylate,NBCA胶)有更高的治疗失败或复发风险,差异有统计学意义(OR=4.70, 95%CI: 1.55~14.28, P<0.05)。结论: 虽然血管内栓塞治疗硬脊膜动静脉瘘的应用日趋广泛,但显微外科手术所获得的临床疗效仍明显优于血管内栓塞治疗。     

不典型硬脊膜动静脉瘘6例临床分析

硬脊膜动静脉瘘(SDAVF)是脊髓血管畸形疾病中最常见的一种,主要表现为横贯性脊髓损害,影像学多表现为长节段脊髓病变伴脊髓表面增多迂曲血管影.该病临床上相对少见,并且可有不典型表现,极易漏诊或误诊为脊髓炎性反应性疾病或椎间盘退行性变等,早期诊断和治疗能明显改善预后.文章对6例不典型SDAVF患者临床特征和实验室资料进行...     

A tiny dural arteriovenous fistula

Pulsatile tinnitus is commonly encountered in approximately 10% of a given population. Since causes of the disease vary, selecting appropriate protocols of imaging strategies is quite challenging. Vascular anormalies or diseases including anormalies of the carotid arteries and jugular veins,intracranial arteriovenous malformation and dural arteriovenous fistula (DAVF) are major causative factors of the disease. Before imaging studies, history inquiry and physical examination are important for detect the possible causes of pulsatile tinnitus. Different imaging examinations are depended on histories and clinical signs of different patients.     

A tiny dural arteriovenous fistula

Pulsatile tinnitus is commonly encountered in approximately 10% of a given population.1 Since causes of the disease vary, selecting appropriate protocols of imaging strategies is quite challenging.2 Vascular anormalies or diseases including anormalies of the carotid arteries and jugular veins, intracranial arteriovenous malformation and dural arteriovenous fistula (DAVF) are major causative factors of the disease. Before imaging studies, history inquiry and physical examination are important for detect the possible causes of pulsatile tinnitus. Different imaging examinations are depended on histories and clinical signs of different patients.     

以颅内蛛网膜下腔出血为表现的脊髓硬脊膜动静脉瘘4例分析

目的分析以颅内蛛网膜下腔出血(SAH)为首发表现的脊髓硬脊膜动静脉瘘(SDAVF)患者的临床和影像学特点。方法回顾性分析2011年8月—2016年10月首都医科大学附属北京地坛医院神经内科确诊4例颅内SAH患者的临床及影像学资料。结果 4例患者男3例,女1例,年龄48~58岁,均以头痛为主诉,发病时伴腰背部疼痛1例。3例患者头颅CT显示出血位于三、四脑室及桥前池,头颅CT未见异常1例。瘘口位于颈髓患者3例,瘘口位于胸腰髓患者1例。全脑数字减影血管造影(DSA)显示供血动脉为左椎动脉3例,脊髓DSA显示供血动脉为腰动脉1例。4例磁共振成像(MR)示髓周血管流空信号或髓内异常信号。手术患者2例,随访后无复发,余2例拒绝手术,失访。结论以颅内SAH为表现的SDAVF患者,临床症状轻,瘘口多位于颈髓,位于胸腰段者罕见。出血与合并引流静脉迂曲扩张有关,易误诊。临床上需仔细询问病史及查体,避免误诊漏诊。     

Immunohistochemical study in dural arteriovenous fistula and possible role of ephrin-B2 for development of dural arteriovenous fistula

Background Although there were several clinical and experimental studies discussing the pathogenesis of dural arteriovenous fistula (DAVF), the pathological process leading to intracranial DAVF so far remains unknown. In this study, we investigated the expression of vascular growth factors in order to elucidate the possible role of these factors for the development of DAVF and to study the biological activity of this uncommon lesion.Methods We examined the histological features, proliferative and angiogenic capacities of the tissue specimens obtained from 6 patients who underwent surgery at our institution. Immunohistochemical staining for vascular endothelial growth factor (VEGF), its receptors FIk-1 and Fit-1, ephrin-B2, MIB-1 and proliferating cell nuclear antigen (PCNA) was performed using standard immunohistochemical techniques.Results A positive immunostaining was found for all antibodies studied except MIB-1, whereas nuclear endothelial expression of PCNA was observed in only 3/6 cases. VEGF stained positive in all of the available specimens (6/6). FIk-1 showed a positive immunoreaction in only 2/6 cases and Fit-1 in 4/6 cases. Ephrin-B2 was expressed in the majority (5/6) of the cases.Conclusions These results support the hypothesis that DAVFs might be acquired dynamic vascular malformations with low biological activity. Vascular growth factors like VEGF and ephrin-B2 might play a pivotal role in the formation of DAVF.