硬脊膜动静脉瘘的手术治疗

目的探讨硬脊膜动静脉瘘的手术方法及术后抗凝治疗。方法回顾性分析手术治疗的ＳＤＡＶＦ１９例,其中胸腰段１４例,骶部５例。手术方法包括：１４例胸腰段者于瘘口水平切断引流静脉。其中１１例可见硬膜外小供血动脉闭,同时电凝。骶部ＡＶＦ均于Ｌ５～Ｓ１水平切断引流静脉。９例行术后抗凝治疗。结果１６例术后脊髓功能改善,其中２例短暂好转后加重,经抗凝治疗后恢复。１例无改变,１例因过度抗凝出现术野血肿,１例残留ＡＶＦ。结论切断连接瘘口及冠状静脉丛的引流静脉是治疗ＳＤＡＶＦ的有效方法。术后抗凝可治疗及预防冠状静脉丛内血栓形成

Surgical treatment of spinal dural arteriovenous fistulas

OBJECTIVE: To discuss the operation modalities of spinal dural arteriovenous fistulae (SDAVFs) and treatment with anticoagulant agents after surgery. METHOD: The medical records, radiographic studies and operations of 23 patients with SDAVFs were reviewed. Laminectomy was performed at the level of the arterialized venous entry into the subarachnoid space in 18 patients with thoracic and lumbar lever AVFs, followed by coagulation, clipping and division of the vein. In 14 of 18 patients, the arteriovenous nidus in the dura was identified and obliterated by coagulation. The draining veins were interrupted at L(5) - S(1) level in 5 patients with sacral AVFs. Anticoagulant treatment was given in 13 patients. RESULT: Outcome was good in 20 patients and 2 of the 20 had transient postoperative neurological deterioration that reversed by anticoagulant agents. No changes were seen in 2 patients except one deteriorated. CONCLUSION: Surgical interruption of arterialized radicular-medullary draining vein of SDAVFs provides lasting occlusion of the fistula, and postoperative anticoagulant therapy can prevent thrombosis of the coronal venous plexus.