硬脊膜动静脉瘘的MRI和DSA影像学特点及栓塞治疗

目的 探讨硬脊膜动静脉瘘的MRI和DSA影像学特点及血管内栓塞治疗方法。方法 12例硬脊膜动静脉瘘患者均行MRI和脊髓血管造影检查,4例行栓塞治疗。分析其MRI和血管造影表现。结果 12例硬脊膜动静脉瘘中,MRI屉示脊髓内弥漫性长T2信号影11例,脊髓斑片状强化2例,脊髓背侧异常血管影6例。脊髓血管造影均能显示其瘘口和引流静脉,并反映其病变范围、供血状况及特征。4例行栓塞治疗患者其临床症状均有改善。结论 脊髓血管造影是诊断硬脊膜动静脉瘘的主要确诊方法。MRI对确定诊断具有重要作用。血管内栓塞是一种有效的治疗方法。     

硬脊膜动静脉瘘

硬脊膜动静脉瘘是脊髓血管畸形中常见的一种,近年对其诊断和治疗的研究已取得很大进步。本文复习最新的有在文献,对其发病机制,病理生理,血液动力学及治疗作一综述。     

脊髓硬脊膜动静脉瘘误诊1例

<正>病人,男,62岁。5年前开始逐渐出现右下肢隐痛,约2个月后出现左下肢疼痛,打喷嚏时无加重。2年前逐渐出现双下肢无力伴麻木,间歇性跛行及尿便失禁。外院胸椎MRI检查提示T10¹2脊髓内异常信号,诊断为多发性硬化,给予地塞米松、丙种球蛋白及营养神经等治疗,但无效。查体:双下肢肌肉废用性萎缩,双下肢肌力Ⅲ12脊髓内异常信号,诊断为多发性硬化,给予地塞米松、丙种球蛋白及营养神经等治疗,但无效。查体:双下肢肌肉废用性萎缩,双下肢肌力Ⅲ^Ⅳ级,     

磁共振成像对硬脊膜动静脉瘘的诊断及随访价值

目的：讨论MRI对硬脊膜动静脉瘘（SDAVF）的初步诊断及随访价值。方法：回顾性分析资料完整的13例SDAVF患者的手术前后或栓塞前后MRI资料。结果：13例患者中手术前或栓塞前诊断为椎间盘突出7例,脊髓炎3例,神经根炎1例,正确诊断2例,误诊率高。分析MRI片提示病灶区脊髓呈现平均连续5个椎体节段长T2信号,T1、T2加权像髓外硬膜下可见密集的血管流空影。10例患者在T1增强中见到迂曲扩张的冠状静脉丛,术后或栓塞后3－6个月复查MRI,长T2信号及血管流空影消失。结论：MRI对硬脊膜动静脉瘘（SDAVF）的诊断治疗具有较可靠的初诊及随访意义,脊髓长T2信号及血管流空影对诊断有意义。     

硬脊膜动静脉瘘诊断、治疗和预后进展

【摘要】 硬脊膜动静脉瘘（SDAVF）是一种临床表现多样、误诊率高的罕见疾病。随着无创血管成像技术发展,SDAVF诊断有了一定提高,但脊髓血管造影仍是诊断SDAVF金标准。SDAVF是一种非自限性疾病,一旦发病均需外科手术或血管内栓塞治疗。随着血管内栓塞材料和技术进步,血管内治疗成功率逐渐增高,但外科手术治疗成功率仍数倍于血管内栓塞治疗。尤其是近年外科手术中微创技术发展,使得SDAVF患者获益更大。治疗成功后大部分患者症状可稳定或改善,而未能获早期诊断和治疗常可导致不可逆性神经功能损伤。该文就SDAVF诊断、治疗和预后研究进展作一综述。     

手术和栓塞治疗硬脊膜动静脉瘘18例

硬脊膜动静脉瘘（Spinal dural arteriovenous fistulas,SDAVF）在脊髓血管疾病中占80%,可引起进行性脊髓功能障碍并在几年内导致完全瘫痪.我院自1990年以来收治18例SDAVF患者,现将治疗效果分析如下.     

硬脊膜动静脉瘘的MRI诊断

硬脊膜动静脉瘘(spinal dural arteriovenous fistula, SDAVF)是脊髓血管畸形的一种,其病理基础是硬脊膜动脉在神经根处与脊髓表面静脉交通,引起脊髓静脉高压,使脊髓内动静脉间压力梯度减小,脊髓组织的血液灌注降低,进而引起神经组织进行性缺血、缺氧[1,2].SDAVF的发病机制、影像学表现及临床治疗与其它类型的脊髓血管畸形不同,本研究着重讨论SDAVF的MRI表现.     

餐饮后发作性截瘫的硬脊膜动静脉瘘1例

<正>病人,男,55岁。5年前无明确诱因出现左下肢麻木无力,3个月后右下肢也出现类似症状。长期按腰椎间盘和前列腺疾病治疗无效,症状逐渐加重,伴腰痛、走路不稳及小便不畅。近半年来出现4次发作性双下肢瘫,均在酒店餐饮后发生,休息2～3 d后肌力可恢复至发病前水平。查体:生命体征平稳,一般内科检查无特殊。神经系统检查:     

硬脊膜动静脉瘘的影像学特点

目的:总结硬脊膜动静脉瘘(SDAVF) 的DSA 及MRI影像学特点,探讨其病理机制。材料与方法:26 例均行全脊髓血管DSA 检查,其19 例行MRI检查。结果:瘘口位于胸段17 例,腰段4 例,骶段5 例,颈段无;26 例患者均只发现1 个瘘口;动静脉直接交通23 例,动静脉间夹杂小畸形团3 例。19 例MRI矢状面上均见血管流空信号,髓内无流空或出血信号,矢状面圆锥部均见T1 WI等或低信号,T2 WI高信号。结论:SDAVF 可发生于除颈段外的任何一段硬脊膜上,瘘口部有两种表现形成:A→V;A→小畸形团→V。脊髓血管DSA 检查是确定SDAVF 诊断的金标准。     

Perfusion-weighted MRI of spinal dural arteriovenous fistula

A 72-year-old woman was admitted with rapidly progressive paraplegia and sphincter disturbance. T2-weighted images of the thoracic spine showed intramedullary high signal with flow voids suggesting dilated medullary veins. Conventional spinal angiography demonstrated a dural arteriovenous fistula draining into perimedullary veins. Perfusion-weighted MRI demonstrated a prolonged mean transit time and increased blood volume in the high-signal area. The loss of normal perfusion gradient and venous hypertension and were thought to produce these differences. The time-to-peak was almost identical in the high-signal and isointense areas, although the bolus of contrast medium arrived earlier in the former. Arteriovenous shunting was thought to cause faster inflow. These changes may have resulted in increased blood volume in the spinal cord. The high signal has been attributed to oedema due to venous congestion, but there has been no histological confirmation. Perfusion MRI in this case supports this hypothesis.     

硬脊膜动静脉瘘的诊断和治疗进展

硬脊膜动静脉瘘(Spinal dural arteriovenous fistulaSDAVF)是一种常见的脊髓血管畸形,多发于50~60岁的男性,是不明原因的获得性病变[1]。其预后取决于就诊时的神经功能缺失情况[2]。由于本病的临床表现常不具有特异性,所以部分病例的诊断相当困难,早期认识本病非常重要。现就本病的病理、诊断及治疗进展进行综述。一、病理及病理生理SDAVF的瘘口常位于椎间孔处脊神经后根的硬脊膜袖口处,可单发或多发,引流静脉增粗并可返流入脊髓表面静脉或静脉丛。供血动脉为根软膜动脉。椎间孔硬脊膜袖口处的动静脉交通使正常的向心引流模式发生逆转…     

Angiography in the investigation of spinal dural arteriovenous fistula

Summary The authors present their protocol for spinal angiography in their investigation of dural arteriovenous fistula (DAVF). The protocol has been used in approximately 120 patients from 1983 to the present at Bicetre Hospital. The approach is based on the fact that venous congestion is responsible for the myelopathy of DAVF. If the venous phase of the spinal circulation is normal, this alone rules out DAVF as the cause of the patient's symptoms. If there is stasis in the spinal circulation, this is consistent with DAVF, and thus complete spinal angiography is necessary. Complete angiography includes the selective intercostal arteries, including the lateral sacrals, as well as the supply to the cervical cord and posterior fossa.     

Diagnosis of spinal dural arteriovenous fistula with multidetector row computed tomography: a case report

Spinal dural arteriovenous fistulas are a rare cause of myelopathy. Nonspecific symptoms may delay the diagnosis. Magnetic resonance imaging and spinal angiography are routinely used to establish the diagnosis. In our case abnormalities on magnetic resonance imaging only suggested spinal dural arteriovenous fistulas. Multidetector row computed tomography (MRCT) led to the diagnosis which was confirmed by angiography.     

硬脑膜动静脉瘘的治疗

目的　探讨不同方法治疗不同类型的硬脑膜动静脉瘘 (DAVF)的疗效。方法　采用经动脉入路在供血动脉内采用低浓度NBCA胶、弹簧圈、游离纤毛钢圈、PVA等栓塞治疗 ;经静脉入路在瘘口静脉端用弹簧圈栓塞 ,或直接开颅手术夹闭瘘口、静脉窦表面颅骨钻孔后直接穿刺作静脉窦内栓塞及静脉内支架植入等方法治疗不同部位和不同类型的DAVF 32例。结果　 8例前颅凹底DAVF ,5例经动脉入路栓塞治疗 ,2例治愈 ,3例临床好转 ;3例 (1例经静脉入路治疗失败后 )前颅凹底入路行开颅瘘口直接夹闭治愈。 14例海绵窦区DAVF ,7例经眼上静脉入路海绵窦内栓塞治愈 ,4例经动脉入路 ,治愈 1例 ,好转 3例。 5例横窦区DAVF ,2例经静脉入路窦内栓塞治愈 ,2例动脉入路栓塞后好转 ,1例行窦孤立手术治愈。 4例多处瘘口的上矢状窦DAVF ,联合多种治疗方法经多次治疗 ,临床好转。 1例左侧颈静脉孔区DAVF联合多种治疗方法经多次治疗治愈。结论　前颅凹底DAVF以直接手术行瘘口夹闭疗效好 ,经动脉入路低浓度胶栓塞可治愈但需注意危险吻合 ;海绵窦区DAVF经静脉入路栓塞多可治愈。横窦区DAVF静脉入路栓塞瘘口静脉端效果好 ;复杂性DAVF治疗困难 ,目前联合多种治疗方法可以达到临床改善。将治疗策略定在针对瘘口的静脉端 ,可望达到临床治愈。     

Double spinal dural arteriovenous fistulas: case report and review of the literature

Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation. It mainly affects men after the fifth decade and is usually an acquired lesion with an unknown etiology. We report on a patient with the unusual finding of two separate SDAVFs at the level of L1 on the right and L2 on the left side. Initial selective spinal digital subtraction angiography (DSA) was terminated with demonstration of a SDAVF at the level of L1 but incomplete demonstration of all segmental arteries. Due to a recurrent deterioration of the patients neurological status, and persistent pathological vessels seen on MRI, a second spinal DSA was performed 6 years later, demonstrating the second fistula at the level of L2 on the left side with a separate venous drainage pattern. A retrospective analysis of the angiographic films suggested that both fistulas had already been present 6 years previously. This conclusion is justified because of a transient and faint opacification of the left L2 fistula demonstrated on the films after injection of the right L2 segmental artery. We conclude that in the case of incomplete angiography and persistent clinical and MR findings not only reopening of the treated SDAVF has to be taken into account but also the existence of a second fistula. Since this is the first case of a double fistula in our series of 129 SDAVFs, and given the few reported cases of double SDAVFs, we do not think that completion of selective spinal DSA has to be postulated routinely after a fistula has been found. However, repeat angiography should be performed in patients who continue to deteriorate, fail to improve with persisting MRI pathologies, or demonstrate delayed deterioration after a period of improvement.     

Enhanced cervical MRI in identifying intracranial dural arteriovenous fistulae with spinal perimedullary venous drainage

Diagnosis of an intracranial dural arteriovenous fistula (DAVF) with spinal perimedullary venous drainage is challenging because the presenting symptoms are usually related to dysfunction of the spine, not of the brain. Repeated spinal angiograms are usually performed before the diagnosis is finally made by cerebral angiography. We report two cases of intracranial DAVFs with spinal perimedullary venous drainage. In both cases contrast-enhanced cervical MRI demonstrated dilated lower brainstem and upper spinal veins, which, we believe, is a good indicator of the existence of such drainage. We suggest that, in cases with perimedullary serpentine enhancement on thoracic or lumbar MR images, additional Gd-enhanced cervical spinal MR imaging should be performed. The simple process of tracing the veins upwards may avoid a lot of unnecessary examinations and delay in the diagnosis. Received: 3 July 1997 Accepted: 6 August 1997     

A dural arteriovenous fistula fed entirely by the lateral sacral artery

We report a spinal dural arteriovenous fistula fed exclusively by the lateral sacral artery to remind neuroradiologists and neurosurgeons that the afferent artery of these lesions may arise from internal iliac arterial branches.