显微手术治疗硬脊膜动静脉瘘16例

目的 总结硬脊膜动静脉瘘（SDAVF）的手术治疗经验。方法 回顾性分析2016年10月至2019年10月显微手术治疗的16例SDAVF的临床资料。结果 术后随访3~26个月,平均14个月。术后症状均有不同程度改善。结论 SDAVF首诊误诊率较高,早期诊断并早期治疗对神经功能损伤的恢复具有积极意义,显微手术治疗是有效的治疗方式。     

硬脊膜动静脉瘘的早期诊断策略

目的硬脊膜动静脉瘘（SDAVF）是一种缓慢进展的脊髓血管性疾病,临床表现无特殊性,容易误诊。现分析3例得到早期诊断病例的资料,以期制定SDAVF早期诊断的策略。方法对近年来得到早期诊断的3例SDAVF患者诊断资料进行分析,总结其临床表现特征、诊断程序及内容。结果3例SDAVF患者均表现为双下肢无力或麻木,运动后加重等特点。磁共振检查出现脊髓周边血管流空影及局部脊髓水肿均高度提示SDAVF,均通过DSA获得确诊。结论对于临床表现疑似SDAVF患者,脊髓MRI扫描和进一步的DSA检查有助于早期诊断,提高治疗效果。     

硬脊膜动静脉瘘:1例报告及专家解读

目的 :探讨硬脊膜动静脉瘘(spinal dural arterio-venous fistula,SDAVF)的临床和影像学特征,以期提高临床上对SDAVF的认识。方法 :报道1例SDAVF患者的临床诊治经过,并邀请神经内科及影像科专家结合相关文献对SDAVF的临床和影像学特征进行解读。结果 :1例SDAVF患者的临床表现为进行性加重的右下肢麻木、行走不稳,麻木自右足小趾沿右腿外侧向上扩展至肛周,并逐步伴有腰部疼痛、二便障碍。胸椎磁共振成像(magnetic resonance imaging,MRI)平扫+增强扫描显示第9胸椎以下呈中心分布的长条状T2加权成像高信号影,增强可见脊髓周围强化小血管影;腰椎MRI平扫+增强扫描显示脊髓圆锥T2加权成像信号增高。在全身麻醉下行SDAVF切除术。术后1.5年进行随访,患者症状明显改善。结论 :SDAVF的临床表现混杂,多不具有特异性;老年人以慢性进行性脊髓病变症状为表现时,应考虑本病可能。脊髓MRI对提示SDAVF诊断具有重要作用,临床医师和影像科医师都应掌握本病的经典MRI特征,尽早做出正确诊断。早期治疗能够改善预后,避免症状恶化至不可逆转。     

脊髓硬脊膜动静脉瘘3例临床特征及影像学特点

目的通过对3例胸段脊髓硬脊膜动静脉瘘(SDAVF)的病例报道,分析该病的临床特征、影像学特点,提高临床医生对SDAVF的认识和诊断水平,减少误诊误治。方法收集3例SDAVF患者的临床资料,对其病史特点、临床特征、脊髓MRI和DSA进行分析。结果 3例患者平均年龄48岁,慢性病程,缓慢进展,表现为下肢运动障碍、深浅感觉障碍、大小便障碍,病初具有波动性,脊髓MRI可见脊髓轻度肿胀增粗和髓内异常信号灶,斑片状轻度强化,脊髓前后有迂曲匍行血管流空影,全部患者经脊髓血管造影明确诊断,经介入栓塞或手术治疗症状均得到改善;糖皮质激素治疗会导致症状恶化。结论 SDAVF以中年多见,缓慢进展,特征表现为波动性下肢无力及小便障碍,极易误诊,脊髓前后迂曲匍行血管流空影是特异性表现,脊髓血管造影是诊断本病的金标准,及早确诊介入栓塞或手术治疗能取得较好疗效,避免残疾。     

颈枕交界区硬脊膜动静脉瘘一例

目的分析颈枕交界区硬脊膜动静脉瘘(SDAVF)的临床表现及神经影像特点,为早期诊断提供依据。方法经临床及影像学诊断1例颈枕交界区SDVAF患者的有关临床资料,结合相关文献进行分析。结果 SDVAF是脊髓动静脉性血管畸形的一种类型,发病率较低,早期症状和体征无特异性,容易误诊和漏诊,对高度怀疑本病的患者,应行脊髓MRI、CTA或脊髓血管造影检查。结论对亚急性或慢性病程的颈髓病变患者,需高度警惕SDAVF的可能性,重视影像学检查,早期诊断及治疗可改善预后。     

表现为脑干充血的颅-颈交界区硬脊膜动静脉瘘的临床及预后分析

目的 分析延-颈交界区硬脊膜动静脉瘘(Spinal dural arteriovenous fistulas,SDAVF)的临床、影像学特点,以提高临床医生对延-颈交界区SDAVF的认识和诊断水平.方法 回顾性分析7例表现为脑干充血的硬脊膜动静脉瘘患者的临床特点、影像学资料.结果 7例患者均为男性,平均年龄57.4岁;...     

320排CTA对硬脊膜动静脉瘘的诊断价值

目的 探讨320排CT血管成像(CTA)对硬脊膜动静脉瘘(SDAVF)的诊治价值.方法 回顾性分析11例SDAVF病人的临床资料,均行320排CTA及DSA检查,以病变的定性诊断、供血动脉、瘘口、引流静脉的显示情况及手术治疗效果等作为观察指标进行分析.结果 320排CTA对11例病人均做出正确诊断,DSA首次检查漏诊2例,经行320排CTA获得相关图像信息后再行DSA检查发现病变.所有病人经手术治疗后随访3个月～2年,短期预后均良好,但术后9～12个月出现神经功能障碍加重3例.结论 320排CTA可良好地立体显示SDAVF病灶的特征及其周围的骨性解剖结构,但其不能动态显示病灶的血流动力学改变,尚不能取代DSA检查.     

13例硬脊膜动静脉瘘的临床特征与误诊分析

目的分析硬脊膜动静脉瘘(SDAVF)的临床、影像学特点、误诊原因,提高临床医生对SDAVF的认识和诊断水平。方法回顾性分析13例脊髓硬脊膜动静脉瘘患者的临床特点、影像学资料。结果 13例患者中12例男性,平均年龄52.3岁。所有患者症状体征均集中在双下肢、二便和性功能。表现为下肢运动障碍、浅感觉障碍、深感觉异常及大小便功能障碍、性功能障碍。3例患者在腰椎穿刺后症状体征曾有加重。以胸腰段脊髓受累为主,可见到脊髓轻度增粗和髓内异常信号灶,脊髓前后有迂曲状、"虫蚀样"的血管流空影;全部患者均经脊髓血管造影明确诊断。11例接受了介入栓塞或手术治疗,10例在治疗后即刻改善,1例复发。4例在糖皮质激素治疗后症状恶化。结论 SDAVF以中老年男性多见,主要表现为进行性加重的运动和感觉功能减退、大小便功能障碍。脑脊液检查无特异性。本病早期临床表现无特异性,容易误诊。脊髓MRI可对其进行初步诊断,是避免误诊的关键,选择性脊髓血管造影是诊断本病的金标准。及早规范的血管栓塞或手术治疗可能取得较好疗效。     

脊髓硬脊膜动静脉瘘的显微外科治疗

目的总结应用术前脊髓血管造影、X-线及术中吲哚菁绿荧光造影技术显微手术切除脊髓硬脊膜动静脉瘘(spinal dural arteriovenous fistulas,SDAVF)的治疗经验。方法回顾性分析8例SDAVF病人的临床资料,在脊髓血管造影、X-线及吲哚菁绿术中荧光造影辅助下行显微手术切除SDAVF,对其疗效进行随访。结果全部病例SDAVF完全切除。随访9~17个月,症状好转7例,稳定1例。结论术前脊髓血管造影、X-线及术中吲哚菁绿荧光造影可以显著提高手术成功率。     

硬脊膜动静脉瘘误诊急性脊髓炎1例并文献复习

目的探讨硬脊膜动静脉瘘(SDAVF)的诊疗方法。方法回顾性分析1例SDAVF病人的临床资料,对其临床表现、MRI检查、脊髓血管造影及显微外科手术预后等进行分析。结果本例起病隐匿,早期误诊为急性脊髓炎,予以对症治疗,效果不明显;后经瘘口夹闭外科手术治疗,症状明显缓解。随访5个月,病人恢复良好。结论本病早期临床表现无特异性,容易误诊,脊髓MRI检查为首选,选择性脊髓DSA是诊断金标准,显微手术可作为首选方法。     

Post-dural puncture related complications after diagnostic lumbar puncture, myelography and spinal anaesthesia

Objectives – This study was conducted to investigate complications after dural puncture. Material and methods – A 15 months' prospective observation study of routine clinical practice with dural puncture at a university hospital was conducted. Quincke spinal needles 0.90 to 1.0 mm O.D. (20–19 g) were used for diagnostic lumbar puncture, 0.70 mm O.D. (22 g) for myelography and 0.40 to 0.50 mm O.D. (27–25 g) for spinal anaesthesia. A questionnaire about post-puncture discomfort was given to the patients, to be returned after 1 week. Results – Of 679 questionnaires 537 (79.1%) were returned. Discomfort was experienced by 53.8% of the patients, most often after diagnostic lumbar puncture and myelography. The difference in incidence of headache after diagnostic lumbar puncture and myelography compared with spinal anaesthesia were 27.9% (95% CI: 18.6 to 37.2) and 18.3% (95% CI: 9.1 to 27.5). Conclusion – Small diameter and atraumatic spinal needles will reduce patients' discomfort after dural puncture.     

Spinal extradural arteriovenous fistulas with retrograde intradural venous drainage: Diagnostic features in digital subtraction angiography and time-resolved magnetic resonance angiography

Spinal extradural arteriovenous fistulas (AVFs) may be more difficult to prospectively identify than dural AVFs because they are less common than dural AVFs. The primary purpose was to further characterize the diagnostic imaging of spinal extradural AVFs with intradural retrograde venous drainage. The magnetic resonance (MR) imaging and angiographic results of 23 patients with suspected spinal dural AVFs were analyzed in order to distinguish dural and extradural AVFs. The diagnostic accuracy of MR angiography was retrospectively compared between dural and extradural AVFs. All 23 patients showed high intensity in the spinal cord on T2-weighted MR images. Eighteen out of 23 patients were diagnosed with dural AVFs, while the remaining 5 were diagnosed with extradural AVFs by angiography. Extradural AVFs were fed by a branch of the segmental artery to the vertebral body, characterized by a fistula located in the ventral extradural space, and drained retrogradely via an epidural venous pouch into intradural veins. The segmental artery was localized within 1 vertebral level using MRA in 12 out of 18 patients (67%) with dural AVFs and in 1 out of 5 patients (20%) with extradural AVFs (p = 0.09). The reasons behind the lower accuracy was mainly the image misinterpretation. Congestion of the spinal cord in spinal extradural AVFs with intradural retrograde venous drainage was similar to that in dural AVFs, whereas its angioarchitecture differed from that of dural AVFs. A clearer understanding of the imaging features of extradural AVFs is important for improving the diagnostic accuracy and clarifying treatment targets.     

Delayed diagnosis of spinal dural arteriovenous fistula in the absence of pathological vessels on MRI

The authors report on a 69-year-old man presenting with progressive leg weakness and gait ataxia over two years. A central intramedullary cord lesion ranging from T8-12 on MR imaging was misdiagnosed as a low-grade glioma and a biopsy was attempted followed by temporary clinical deterioration. Selective spinal angiography revealed a spinal dural arteriovenous (AV) fistula on the left L3 nerve root sheath despite the absence of pathological vessels on MR imaging. The fistula was successfully treated by microsurgical interruption of the arterialized intradural vein. The present case should remind us to include selective spinal angiography in our diagnostic work-up in patients predisposed for spinal dural AV fistula by male sex, advanced age and clinical presentation of slowly progressive sensorimotor symptoms with myelopathy on MR imaging, even in the absence of any pathological vascular structures.     

硬脊膜动静脉瘘6例临床和影像学特点分析

目的 探讨硬脊膜动静脉瘘（spinal dural arteriovenous fistula,SDAVF）的临床和影像学特点,提高对于SDAVF的认识。方法 对6例确诊SDAVF患者的临床、影像学资料以及治疗与转归等进行回顾性分析。结果 6例患者中5例为中老年男性,1例为青年女性。6例患者的病灶部位均在胸腰段脊髓,其中3例有脊髓圆锥及马尾神经根受累。双下肢麻木症状发病3例,骶尾部或双下肢疼痛发病2例,下肢无力发病2例,6例患者均有尿便和性功能障碍,1例急性起病,5例亚急性或慢性起病。2例呈进行性病程,无明显波动,4例病程中病情有明显波动。脊髓磁共振检查（magnetic resonance imaging,MRI）全部病例均见到脊髓轻度增粗和髓内弥漫性长T2异常信号灶,4例脊髓表面尤其是背侧可见到迂曲血管流空影,腰骶段受累病例更加明显。6例均行脊髓数字减影血管造影（digital subtraction angiography,DSA）检查,见到供血动脉形成的动静脉瘘口以及明显蜿蜒迂曲延长的引流静脉从而确诊本病。全部6例患者的临床体征水平与影像学上病变水平均不甚一致,影像学表现重于临床。4例患者接受了1～3次的介入栓塞治疗,其中3例取得较好疗效,但这3例患者均有复发。结论 SDAVF有其临床和影像学特点。男性中老年患者多见,主要为胸段脊髓或腰骶段脊髓、神经根的症状体征,下肢感觉异常、疼痛、步态异常或运动障碍、尿便和性功能障碍均是常见的临床表现,可先后受累。病程可呈慢性进展,可在波动中进展,也可以进展中有波动。脊髓MRI检查对于本病的诊断可有提示。及早规范的血管栓塞或手术治疗可能取得较好疗效。     

脊髓动静脉畸形的显微外科治疗

作者5年内共行脊髓动静脉畸形显微外科切除术35例。本文总结本组病人的临床表现,讨论本病的分型和显微外科切除技术。由于本病缺乏独特的症状和体征,易误诊为其它脊柱脊髓疾病。诊断上最主要的方法是MRI和选择性脊髓血管造影,一般说来,硬脊膜和脊髓表面动静脉瘘可成功地完全切除,但团块型AVM的治疗却是一个复杂的外科问题。显微外科切除术的关键是良好显露,彻底止血和尽可能多处理供血动脉。     

Intracranial dural arteriovenous fistula draining into spinal cord veins: case report

We present an usual case of intracranial dural arteriovenous fistula with perimedullary and spinal cord venous plexus drainage and discuss its etiological, physiopathological, diagnostic and therapeutic aspects.     

Wirbelsäulensyndrom, ausgelöst durch eine lumbale spinale AV-Malformation

We report the case of a 64-year-old male suffering from long-term claudicatio spinalis who underwent surgery in an orthopedic outpatient ward for posterior lumbar interbody fusion and bony decompression due to spinal stenosis. Postoperatively, the clinical symptoms, consisting of difficulties with walking and stocking-like dysesthesia of both lower extremities, did not improve. Due to persistent complaints, spinal MRI was performed which revealed myelomalacia and moreover was indicative of dural arteriovenous (AV) malformation at the L2-3 spinal level, which was verified as a type Ia AV fistula (according to Spetzler) by digital subtraction angiography (DSA). After microsurgical treatment of the AV fistula, clinical symptoms improved and control DSA could demonstrate complete disconnection of the fistula without any signs of recanalization. This case demonstrates that neurological deficits of patients suffering from degenerative spinal disorders can generally be considered as caused by more common spinal disease such as lumbar stenosis. Since vascular malformations may also cause neurological deficits and even mimic symptoms of spinal stenosis, it is important to consider these entities in diagnostic evaluation.     

Remote cerebral and cerebellar hemorrhage after massive cerebrospinal fluid leakage

Dural tears can occur during spinal surgery and may lead to cerebrospinal fluid (CSF) leakage which is rarely involved in remote cerebellar hemorrhage. Only a few of cases of simultaneous cerebral and cerebellar hemorrhage have been reported in the English literature. We experienced a case of multiple remote cerebral and cerebellar hemorrhages in a 63-year-old man who exhibited no significant neurologic deficits after spinal surgery. Magnetic resonance imaging (MRI) performed 4 days after the surgery showed a large amount of CSF leakage in the lumbosacral space. The patient underwent the second surgery for primary repair of the dural defect, but complained of headache after dural repair surgery. Brain MRI taken 6 days after the dural repair surgery revealed multifocal remote intracerebral and cerebellar hemorrhages in the right temporal lobe and both cerebellar hemispheres. We recommend diagnostic imaging to secure early identification and treatment of this complication in order to prevent serious neurologic deficits.     

脊髓硬脊膜动静脉瘘的临床特点(附2例报道和222例文献分析)

目的探讨脊髓硬脊膜动静脉瘘的发病机制和临床特征,以增进对该病的认识,减少误诊误治。方法报道2例临床病例,附1例手术和病理所见。结合文献中222例报道,进行临床分析。结果脊髓硬脊膜动静脉瘘是脊髓动静脉性血管病变的一种类型,临床表现为进行性、上行性的双下肢运动、感觉、大小便功能障碍,由于该病早期的症状和体征无特异性,易造成误诊,脊髓MRI和脊髓血管造影有特征性表现。结论对急性、亚急性病程的脊髓病变患者的MRI图像认真分析,并进行选择性脊髓血管造影检查,有利于早期确诊本病。早期诊断、早期治疗可以较好地改善临床症状。     

硬脊膜动静脉瘘五例误诊分析

目的探讨硬脊膜动静脉瘘的临床特点及误诊原因。方法分析5例确诊的硬脊膜动静脉瘘的临床、MRI及DSA表现。结果 5例中仅1例急性起病,表现为一侧肢体无力,误诊为急性脑梗死;余4例均慢性病程,表现为双下肢无力和麻木,部分伴有尿频和便秘。其中2例误诊为腰椎间盘突出,2例误诊为多发性硬化,1例误诊为脊髓炎,并予激素治疗后症状无明显好转,仍进行性加重。结论本病早期临床表现无特异性,容易误诊,脊髓MRI为首选,及时行此检查是避免误诊的关键;选择性的脊髓血管造影是诊断本病的金标准。