脊髓动静脉性血管病变的诊断与治疗(附99例报告)

目的探讨脊髓动静脉性血管病变(SCAVLs)的诊断与治疗。方法自1990年8月至2006年8月,我们收治99例SCAVLs,并回顾性分析他们的影像学改变、治疗方法与结果。结果99例脊髓动静脉性血管病变中,行手术治疗65例,介入治疗34例。手术治疗病例中,脊髓动静脉畸形(SAVM)31例、硬脊膜动静脉瘘(SDAVF)26例和髓周动静脉瘘(PMAVF)8例,各型SCAVLs病例术后获好转者分别为19例、17例和4例。结论脊髓MRI和DSA是正确诊断本病的关键。对SDAVF和Ⅰ型PMAVF宜首选手术治疗,对SAVM应尽可能采用手术切除(或术前辅以栓塞治疗)畸形灶,对Ⅱ型或Ⅲ型PMAVF宜取介入治疗或介入与手术联合治疗。治疗时,应针对动静脉短路进行根治性治疗,即手术和/或栓塞来闭塞瘘口和去除畸形灶。

Diagnosis and treatment of spinal cord arteriovenous lesions ( a report of 99 cases)

Objective To probe into the diagnosis and the treatment of spinal cord arteriovenous lesions(SCAVLs). Methods From Aug 1990 to Aug 2006, we treated 99 patients with SCAVLs, the image changes, therapeutic methods and results of which were reviewed. Results Of 99 patients with SCAVLs, 65 patients underwent surgical treatment, and 34 patients did interventional therapy. Of 65 patients undergone surgery, there were 31 patients with spinal arteriovenous malformations (SAVMs), 26 spinal dural arteriovenous fistulas (SDAVFs) and 8 perimedullary arteriovenous fistulas (PMAVFs). Postoperative neurological status were improved in 19 patients with SAVMs, 17 patients with SDAVFs and 4 patients with PMAVFs. Conclusions Spinal MRI and DSA are the key points of correct diagnosis of SCAVLs. SDAVF and the type I of PMAVF are amenable to surgery. For SAVM, surgical removal of deformation focus (or with the assistance of embolotherapy before operation) is employed as far as possible. For the type II and III of PMAVF, interventional therapy or interventional therapy combined with surgical therapy is adopted. When treated, radical treatment, aiming directly at arteriovenous shunt, should be carried out, that is, fistula and deformation focus should be eliminated by means of surgery and/or embolotherapy.