脊髓髓内动静脉畸形血管构筑学分析及其对治疗的启示

目的　探讨脊髓髓内动静脉畸形(SAVM)的血管构筑从而选择适宜的治疗方式。材料和方法　回顾性分析本中心治疗的120例SAVM病人的临床资料、血管造影影像资料及治疗方法和效果。结果　根据脊髓髓内动静脉畸形团的形状，将AVM分成两种类型：团块型和幼稚型。血管构筑学分析包括供血动脉、供血方式、伴随病变。其供血动脉为脊髓前动脉、脊髓后动脉和/或软膜动脉。经超选择脊髓血管造影可见畸型团有5种构筑方式：(1)终末供血形式，本组104例行栓塞治疗，其中85例单纯栓塞，70例神经功能恢复与改善；19例行术前栓塞、减少术中出血；(2)穿支供血形式本组16例，少量部分的用颗粒栓塞，栓塞后症状均改善；(3)动静脉直接交通1例；(4)AVM伴有动脉瘤13例，首先行动脉瘤栓塞；(5)AVM含有静脉动脉瘤样扩张2例。结论　脊髓髓内AVM的血管构筑学有助于选择治疗方案，终末型供血可行胶栓塞。穿支供血只能少量部分的用颗粒栓塞。AVM内的动脉瘤应首先栓塞，可明显减少再出血的危险。团块型AVM术前栓塞有利于手术切除。幼稚型AVM只能栓塞治疗。

Analysis on Angioarchitectures of intramedullary Arteriovenous Malformations(AVMs) and Appropriate Therapy

Objective To analyze angioarchitectures of intramedullary arteriovenous malformations(AVMs) and appropriate therapeutic alternatives.Methods Clinical and angiographic data, therapeutic remedies and effects were analyzed retrospectively among patients with intramedullary AVMs in our interventional center.Results The patients intramedullary AVMs were divided into glumous and juvenile types,according to shape of the nidus of intramedullary AVMs. The angioarchitectural analysis emphasized on feeding arteries included anterior spinal artery(ASA), posterior spinal artery(PSA) and/or pial artery.Superselective angiography showed 5 types of angioarchitectures,(1)In this group,terminal supply of 104 patients accepted endovascular treatment,among which 85 patients accepted simple embolization therapy,70 patients recovered,19 patients received embolization preoperationally to lessen intraoperative bleeding.(2)On perforation branch of 16 patients were embolized with particulate and recovered.(3)Direct arteriovenous shunt one case.(4)13 cases with associated aneurysm were received embolization of aneurysms firstly. (5) AVM associated venous pouch 2 cases. Conclusion Analysis of the angioarchetectures of intramedullary AVMs is helpful to make therapeutic proposal. Those with terminal supply are prefer treated with glue embolization. Those with on perforation branch supply can only be treated by partial particular embolization. Aneurysms within AVMs should be embolized firstly to lessen rebleeding. Preoperative embolization of glomous AVMs is beneficial to surgical excision. Embolization is an unique treatment for juvenile AVMs.