硬脊膜动静脉瘘临床及影像学特点分析(附9例报告)  

Clinical and radiological features of spinal dural arteriovenous fistula: a retrospective analysis of nine cases

作　　者：胡洪涛[1] 唐澍[1] 闫立荣[1] 马志刚[1] 李墨[1] 郭笑磊[1] 姜明[1] 闫欣[1] 庞英[1] 

机构地区：[1]北京积水潭医院神经内科,北京100035

出　　处：《中风与神经疾病杂志》2015年第11期999-1003,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的总结分析硬脊膜动静脉瘘的临床及影像学特点,加深认识,提高诊治水平。方法回顾性分析2004年6月-2014年9月在北京积水潭医院确诊的一组9例硬脊膜动静脉瘘患者的临床、影像学及治疗转归资料,总结其临床及影像学特点。结果 9例患者中男8例,女1例。病变部位：2例累及颈段,3例累及胸段,4例累及腰骶段及马尾神经根。缓慢进展4例,病程中有波动3例,误诊为其他疾病并在应用激素后病情突然恶化2例。临床上表现为不对称的横贯性脊髓和（或）神经根症状体征,二便和性功能全部受累。脊髓MRI多表现为长节段脊髓病变,T2像矢状位上见到＂铅笔征＂,还可以在髓周见到串珠样、虫蚀样、或管样的多发血管流空影。受累节段越靠近腰骶段及马尾区,髓周见到异常血管流空影比例更高,病程中症状波动机会也更多。脊髓DSA检查见到动静脉瘘口和粗大迂曲扩张的引流静脉确诊。瘘口阻断手术和介入栓塞治疗都是可以选择的治疗办法。本病可以有复发,本组介入栓塞治疗组复发率更高。激素治疗后病情恶化的2例患者在明确诊断、尽快行手术治疗后,仍然可以逐渐缓慢恢复。结论 SDAVF是一组在临床和影像学上有其特点的疾病,脊髓MRI检查有助于诊断,脊髓DSA检查是确诊的手段,当怀疑或者临床不排除本病可能时,避免首先使用激素治疗,而应当先尽早明确诊断。瘘口阻断手术和介入栓塞治疗都是治疗SDAVF的有效方法,即使是激素应用后病情恶化的患者,及早进行手术或栓塞治疗也是有帮助的。Objective To investigate the clinical and radiological features of spinal dural arteriovenous fistula（ SDAVF）. Methods By retrospectively analyzing the clinical presentation,radiological features,and treatment-related outcome of nine SDVAF cases diagnosed in our department. Results Of all eight male patients,location of the fistula was at cervical level in 2 patients,at thoracic level in 3 patients,at lumbosacral and cauda equina level in 4 patients. 4 patients had subtle progressive onset of neurological deficits,3 patients had fluctuation,whereas 2 patients suffered from acute deterioration of symptoms with misdiagnosis and subsequent treatment with steroids. The presenting clinical manifestations are asymmetric transverse myelopathy with or without nerve root symptoms,impaired urinary function and impaired sexal function. Characteristic features on spinal MRI include longitudinally extensive spinal cord lesion（ LESCL）,＂pencil-like sign＂in sagittal T2 sequence,and prominent flow voids in the extramedullary and intradural space. Abnormal arteriovenous shunt and tortuous dilated perimedullary veins detected by spinal digital subtraction angiography（ DSA） confirm the diagnosis.Both surgical disruption of the pathological arteriovenous junction and endovascular treatment are considered to be effective treatment modalities. In our study,more recurrence of SDAVF has been detected in endovascular treatment group. 2 firstly misdiagnosed patients suffered from worsening finally achieved improvement in neurological symptoms after surgical therapy as soon as correct diagnosis was established. Conclusion SDAVF is characterized with specific clinical manifestations and radiological features. Serial imaging including spinal MRI and spinal DSA provides the definitive diagnosis of SDAVF. Steroids should be avoided if SDAVF is suspected,thus early diagnosis is preferable. Surgical and endovascular treatment are effective treatment modalities. Although symptoms exacerbated after steroids treatment,they can still

关 键 词：硬脊膜动静脉瘘 磁共振成像 数字减影血管造影 治疗 

分 类 号：R744.1[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]