硬脊膜动静脉瘘的诊断、治疗和临床研究进展（附7例报告）.doc

冃IJ 吕硬脊膜动静脉痿(spinal dural arteriovenous fistulas, SDAVF)由 Kendall 在 20 世纪 70年代首次描述并报道，是指供应硬脊膜或神经根的动脉在椎间孔处穿过硬脊膜时， 与脊髓引流静脉形成的直接通道SDAVF是一种常见的脊髓血管畸形，约占所有脊髓动静脉畸形的70%1926年, Foix和Alajouanine首次报道了这种疾病所致脊髓损伤的晚期病理形态，称之为 Foix-Alajouaninc综合征他们认为这是一种哑急性坏死性脊髓炎”，其血管病理学基 础，直至50年后才由Kendall和Logue认识清楚，认为SDAVF是硬脊膜在椎间孔平 面出现动静脉间的微小痿口(约140|im)所致的一系列异常改变尽管其起因不明，但冃前越来越多的学者认为是由后天逐渐形成的脊髓功能障 碍主要由脊髓静脉高压、缺血、水肿、脱髓鞘及坏死所致活动、腰穿、造影、外伤 可加重症状，其自然病程在3〜5年内可完全瘫痪，所以必须在不可逆损害前尽早阻断 动静脉交通，解除静脉高压，就可以较好地改善临床症状，尽可能减少患者的神经功 能缺损表现SDAVF临床表现没有特异性，常呈隐匿性发病。

因此，早期诊断、早期治疗显得 非常重要随着MRI、CTA和DSA检查技术的发展，SDAVF的检出率也逐年提高， 目前被学者们普遍接受的治疗方法为外科手术和血管内栓塞随着介入神经放射学和 显微神经外科学的飞速发展，目前对该病的认识、诊断和治疗均有了很大的进步自2011年01月至2014年03月，我院神经血管病外科对7名硬脊膜动静脉痿患者行 DSA检查和手术治疗，对上述病例进行病例分析并结合文献复习，探讨硬脊膜动静脉 痿的诊断、治疗和临床研究进展中文摘要硬脊膜动静脉痿的诊断、治疗和临床研究进展(附7例报告)硬脊膜动静脉痿(spinal dural arteriovenous fistulas, SDAVF)由 Kendall 在 20 世纪 70年代首次描述并报道，是指供应硬脊膜或神经根的动脉在椎间孔处穿过硬脊膜时， 与脊髓引流静脉形成的直接通道SDAVF是一种常见的脊髓血管畸形，约占所有脊髓动静脉畸形的70%1926年, Foix和Alajouanine首次报道了这种疾病所致脊髓损伤的晚期病理形态，称之为 Foix-Alajouanine综合征他们认为这是一种，亚急性坏死性脊髓炎”，其血管病理学基 础，直至50年后才| Kendall和Logue认识清处，认为SDAVF是硬脊膜在椎间孔平 面出现动静脉间的微小痿口(约140|im)所致的一系列异常改变。

尽管其起因不明，但目前越来越多的学者认为是由后天逐渐形成的脊髓功能障 碍主要由脊髓静脉高压、缺血、水肿、脱髓鞘及坏死所致活动、腰穿、造影、外伤 可加重症状，其自然病程在3〜5年内可完全瘫痪，所以必须在不可逆损害前尽早阻断 动静脉交通，解除静脉高压，就可以较好地改善临床症状，尽可能减少患者的神经功 能缺损表现SDAVF临床表现没有特异性，常呈隐匿性发病因此，早期诊断、早期治疗显得 非常重要随着MRR CTA和DSA检查技术的发展，SDAVF的检出率也逐年提高， 冃前被学者们普遍接受的治疗方法为外科手术和血管内栓塞随着介入神经放射学和 显微神经外科学的飞速发展，目前对该病的认识、诊断和治疗均有了很大的进步自2011年01月至2014年03月,我院神经血管病外科对7名硬脊膜动静脉痿患者行 DSA检查和手术治疗，对上述病例进行病例分析并结合文献复习，探讨硬脊膜动静脉 痿的诊断、治疗和临床研究进展目的：分析硬脊膜动静脉搂(spinal dural arteriovenous fistulas, SDAVF)的临床、影像学 特点，探讨诊断、治疗方法，提高对SDAVF的认知和诊治水平资料与方法：回顾性分析7例SDAVF患者的临床资料，所有患者均在术前接受MRI及DSA检 查，并在确定痿口部位后接受手术治疗，切断供血动脉及痿口，术后给予抗凝治疗。

结果：所有患者均在治疗后症状得到改善，下肢疼痛以及麻木力弱等症状缓解最为明显, 尿便功能障碍也有大部分改善7例中，随访3个月〜2年，采用改良Amilnoff-Logue评分: 术后改善6例(85.7%),无变化1例(14.3%),无加重或恶化其中步态及下肢力量改 善］分2例(28.6%),改善2分3例(42.9%),无变化1例(14.3%)；排便功能改善2 分2例(28.6%)以上患者在随访期间均无复发结论：SDAVF以中老年男性多见，主要表现为进行性加重的运动和感觉功能减退，尿便 功能障碍，脊髓MRI可对其作出初步诊断，选择性脊髓血管造影是诊断的金标准并能 精确定位痿口治疗可采用手术切除痿口或介入栓塞供血动脉早期诊断和早期治疗 可以较好的改善临床症状硬脊膜动静脉痿；临丿木特点；栓塞治疗；手术；综合治疗ABSTRACTAdvancement in the diagnosis, therapy and clinical study of spinaldural arteriovenous fistula (7 cases report attached)Objective:Spinal dural arteriovenous fistulas were firstly described and reported by Kendall in 1970s, which are defined as abnormal arteriovenous shunts within the dura adjacent to intervertebral foramen supplied by the dural or nerve root arteries and drained by the perimedullary veins.SDAVFs are the most common type of vascular malformations of the spine, which constitute approximately 70% of all spinal AVMs. In 1926, Foix and Alajouaninc firstly described the pathological type in terminal stage of the spinal cord injury caused by SDAVFs. They regarded it as subacute necrotizing myelitis. The basis of vessel pathology was clearly acquainted by Kendall and Logue until 50 years later. They considered that SDVAFs were tiny vessel fistula(about 140pm) within spinal dura adjacent to intervertebral foramen and caused a series of abnormality.Although the exact pathogenesis of SDAVFs is not clear, more and more scholars considered that the formation is caused by acquired factors. The spinal dysfunction is mainly caused by the hypertension of spinal vein, ischemia, edema, demyelination and necrosis. Besides, movement, lumbar puncture, DSA, and injury could exacerbate the symptoms. Most paticncts will turn into the irreversible stage as paralysis within the natural course of 3 to 5 years, so it is essential to occlude the shunting zone from the fistula and minimize the duration of spinal cord venous hepertension and reduce the likchood of permanent paraparesis, which can lead to improvement of symptoms.The initial symptoms of SDAVFs are nonspecific and always attack invisibly. Therefore, it is indispensable to make an early diagnosis and treatment. With the development of diagnosis technique, such as MRI, CTA and DSA 、 the relevance ratio of SDAVF is increasing by years・ There are two options in the treatment of SDAVFs: surgical occlusion or endovascular embolization. With the rapid development of interventional neuroradiology and microneurosurgery, scholars have made further acknowledgement with SDAVFs to improve the diagnosis and treatment methods.From Jan. 2011 to Mar. 2014, 7 SDAVFs patients had been examined by DSA and treated by surgical occulsion in the Neurovascular Department of the 1st Hospital of Jilin University. We analyzed retrospectively with these cases to discuss the diagnosis, treatment and clinical research progress of SDAVFs.Purposes:To analyze the clinical and imaging features, discuss the methods of diagnosis and treatment, made further acknowledgement with SDAVFs to improve the diagnosis and treatment level.Datas and Methods:Retrospective analyzing clinical data of 7 SDAVFs cases, all the patients accepted MRI and DSA to locate the fistula sites and then accepted surgical occlusion t。