硬脊膜动静脉瘘血液动力学改变的血管造影表现

目的探讨硬脊膜动静脉瘘血液动力学改变的血管造影表现.方法回顾性分析28例硬脊膜动静脉瘘的选择性血管造影与栓塞治疗资料,所有患者均行全脊髓动脉血管造影检查.结果 28例硬脊膜动静脉瘘经血管造影检齐均能明确诊断,能显示病变的范围、血供情况及其特征,其特点为硬脊膜动脉与脊髓表面静脉直接相通.18例(64.3%)硬脊膜动静脉瘘位于脊柱左侧,10例(35.7%)位于右侧,23例瘘口(82.1%)位于胸3与腰2椎体平面之间.经超选择插管后17例患者接受了栓塞治疗,其中12例行栓塞后手术切除,随访观察见患者临床症状改善者11例(64.7%),病情稳定者4例(23.5%),病情加重者2例(11.8%).所有栓塞病例均无严重并发症发生.结论血管造影是反映硬脊膜动静脉瘘血液动力学改变的重要手段.

Angiographic Appearances of Hemodynamic Change of Spinal Dural Arteriovenous Fistulae

Objective To explore the angiographic appearances of the hemodynamic change of spinal dural arteriovenous fistulae (SDAVF). Methods Twenty-eight patients with SDAVF undergoing selective angiography and embolization were analyzed retrospectively. Using Seldinger technique, angiography of each pair of intercostals, lumbar arteries, bilateral vertebral arteries, bilateral thyrocervical and costocervical trunks was performed. Results Of the 28 patients who underwent selective angiography of SDAVF, the extents of lesion, the amount of vascularity and the nature of the feeding vessels were defined. The angiographic features were: spinal dural artery shunted with the superficial veins of spinal cord. The SDAVFs were found twice as often on the left side, compared with the right. A total of 82.1% of the SDAVFs were located between T3 and L2. By superselective catheterization, 17 cases were embolized, including resection after embolization in 12 cases. After treatment, 12 patients showed improvement (64.7%), the conditions of 4 patients (23.5%) were unchanged (without further deterioration), and the conditions of two patients had deteriorated. There were no severe complacations during embolization. Conclusion Angiography is an important method for reflection of the hemodynamic change of SDAVF.