引起脊髓功能障碍的硬膜动静脉瘘的临床特点

目的 回顾性研究引起脊髓功能障碍的硬膜动静脉瘘（DAVF）的临床特点，促进此类疾病的早期诊治。方法 对15例引起脊髓功能障碍的DAVF患者进行诊治。手术相关性DAVF1例，自发性DAVF14例。缓慢起病11例，急性起病4例。磁共振T2加权脊髓周围异常血管流空11例，脊髓被增强7例。血管造影证实硬膜瘘口位于小脑幕1例，颈段4例，胸段7例，腰骶尾段3例。手术靠近瘘口切断引流静脉6例，介入栓塞瘘口6例，介入后手术2例，保守治疗1例。结果 1例手术治疗患者失随访，1例拒绝手术治疗的患者确诊后1周死亡，其余13例患者随访时间为6-58个月。5例手术治疗的患者均治愈；6例介入治疗的患者，3例治愈，2例好转，1例无变化；2例介入后手术治疗的患者，1例好转，1例双下肢顽固性疼痛无变化。结论 掌握引起脊髓功能障碍的DAVF的起病形式、磁共振特点和血管造影检查要点，有利于DAVF的早期诊治、提高治愈率和患者的生命质量。

The clinical features of dural arteriovenous fistula presenting with meylopathy

Objective Dural arteriovenous fistula(DAVF)is a rare cause of myelopathy. Nonspecific symptoms may delay the diagnosis.So it is necessary to retrospectively study the clinical features of DAVF presenting with meylopathy.Methods Fourteen cases were spontaneous,and one case was a complication of operation.Clinical histories of eleven cases were characterized by slowly progressive and fluctuating deterioration.Enlarged vessels on the spinal cord surface,the most specific magnetic resonance (MRI)finding,was noted in eleven patients,and parenchymal enhancement was noted in seven patients. The selective angiography disclosed one DAVF was tentorial,four cervical,seven thoracic,three lumbo sacral.Draining vein between fistula and spinal cord was interrupted by operation in six patients,by endovascular embolization in six,and re-operation due to recurrence after embolization in two.Results Follow-up periods ranged from six months to fifty-eight months.The results that were obtained on thirteen patients showed complete recovery in eight patients,improvement in three,and no change in two.One of the patients had persistent intractable pain in lower extremity,and follow-up MRI images after surgery showed persistent enhancement of the thoracic cord.The patient of tentorial DAVF refused operation and died of respiratory failure in one week after diagnosis.Conclusions It is useful for early diagnosing and treating DAVF that grasping the clinical features of DAVF presenting with meylopathy.