复合手术治疗硬脊膜动静脉瘘31例分析

目的 探讨复合手术治疗硬脊膜动静脉瘘（SDAVF）的疗效。方法 回顾性分析2014年8月至2019年7月复合手术治疗的31例SDAVF的临床资料。术中DSA技术定位瘘口，据造影结果调整动脉夹，并验证瘘口闭塞的安全性和准确性。术后平均随访（28.9±2.7）个月，采用Aminoff-Logue评分（ALS）评价脊髓功能。结果 31例瘘口位置均准确定位，无扩大切口以暴露病灶，术后造影显示瘘口均消失。末次随访ALS（3.3±0.5）分]较术前（4.4±0.5）分]明显降低（P<0.05）；好转14例，无变化4例，加重2例，好转率为66.7%。随访期间无复发病例。结论 复合手术SDAVF安全、有效，与血管内栓塞相比，解决了其早期失败率及晚期复发率高的问题；与显微手术相比，实现了术中精准定位及实时效果评价。

Hybrid operation for spinal dural arteriovenous fistulas (report of 31 cases)

Objective To summarize the experience in treating spinal dural arteriovenous fistulas (SDAVF) using hybrid operation. Methods A retrospective analysis was performed on 31 patients with SDAVF who received hybrid operation from August 2014 to July 2019. Intraoperative DSA was used to locate the fistula. During the clipping, the clips was adjusted and the safety and accuracy of fistula occlusion were verified by intraoperative angiography. The mean follow-up time after surgery was (28.9±2.7) months, Aminoff-logue score (ALS) for myelopathy was used to evaluate the spinal function. Results All the fistulas were accurately located in 31 patients by intraoperative DSA. No one needed to enlarge the incision to expose the lesion. The fistulas disappeared in all the patiets. The ALS at last follow-up (3.3±0.5) points] was significantly higher than that (4.4±0.5) points] before operation (P<0.05). No fitulas recured during the follow-up. Conclusions Hybrid operation is a safe and effective treatment method for patients with SDAVF. Compared with endovascular embolization, hybrid operation can solve the problem of high early failure rate and late recurrence rate. Compared with microsurgery, hybrid operation can achieve precise intraoperative positioning and real-time effect evaluation.