延-颈髓交界区硬脊膜动静脉瘘六例的诊治

目的探讨延．颈髓交界区硬脊膜动静脉瘘的临床特点、诊断和外科治疗。方法对6例经脊髓MRI及DSA检查确诊的延．颈髓交界区硬脊膜动静脉瘘患者，行经枕下后正中入路，电凝阻断瘘口显微外科手术治疗，其中1例先行血管内瘘口栓塞，后行手术治疗，术后随访2个月至10年。结果术后椎动脉造影复查显示瘘口及粗大的引流静脉影消失。3例患者症状逐渐缓解，双下肢肌力恢复至Ⅳ级，大小便能够自控，未见复发；2例患者症状无改善；1例患者死于术后肺部感染。结论显微外科手术直视下切除延-颈髓交界区硬脊膜动静脉瘘口，疗效较栓塞治疗更为确切。早期诊断并及时消除引起静脉高压的始动因素，保证脊髓静脉引流的通畅，是获得较好疗效的关键。

Dural arteriovenous fistula at the cervicomedullary junction : diagnosis and treatment of 6 cases

Objective To investigate the clinical features, diagnosis and treatment of dural arteriovenous fistula at the cervicomedullary junction. Methods The data of 6 patients with dural arteriovenous fistula at the cervicomedullary junction diagnosed by the authors were analyzed. Microsurgical treatment was performed in 6 cases via median suboccipital approach,and in one of them the operation was carried out after embolization via femoral artery. Results Vertebral arteriography showed fistulas and shadows of gross draining veins disappeared after operations. During the follow-up period from 2 months to 10 years after the microsurgical disconnection of the shunt, 3 cases improved their muscle strength of both lower extremities and no recurrence, 2 cases had no change of their symptoms and 1 case died of pulmonary infection. Conclusion Therapeutic effect of direct microsurgical disconnection of the shunt on dural arteriovenous fistula at the cervicomedullary junction is more effective than embolization. Early diagnosis,elimination of the initial factors of venohypertension,and to keep the drainage of spinal veins unobstructed, is the key for better results.