脊髓髓内动静脉畸形的复合手术治疗  

Hybrid operation for patients with intramedullary arteriovenous malformation:report of 7 cases and literature review

作　　者：王栋良 李连陵 王子岩[1] WANG Dong-liang;LI Lian-ling;WANG Zi-yan(Department of Neurosurgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052

出　　处：《中国临床神经外科杂志》2022年第11期885-888,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨脊髓髓内动静脉畸形(IAVMs)的临床特点以及复合手术的临床疗效。方法回顾性分析2017年9月至2021年6月在复合手术室行显微手术治疗的7例IAVMs的临床资料。先行DSA定位,显微镜下完全显露畸形血管团,术中DSA美兰实时显影技术精准判断供血动脉、引流静脉。结果7例均顺利完成手术,其中6例畸形血管团全切除,术后即刻DSA显示供血动脉、畸形血管团、引流静脉不显影;1例胸段IAVM因部分病灶深入脊髓腹侧,在阻断供血动脉及引流静脉后仅进行部分切除。7例术后随访9~54个月,平均(27.7±16.5)个月;术后9个月McCormick分级Ⅰ级2例,Ⅱ级2例,Ⅲ级1例,Ⅳ级2例;末次随访,7例症状均改善,无死亡病例;除部分切除的1例外,其余6例复查MRI未见迂曲血管影及畸形血管团。结论IAVMs临床少见。在电生理监测下,运用术中DSA美兰实时显影辅助显微手术切除IAVMs,可取得较好的临床疗效。Objective To investigate the clinical features,surgical outcomes of intramedullary arteriovenous malformation(IAVMs).Methods The clinical data of 7 patients with IAVMs who underwent microsurgery in the hybrid operation room from September2017 to June 2021 were retrospectively analyzed.DSA localization was performed on all the patients,then the AVMs were completely exposed under the microscope,and the feeding arteries and draining veins were accurately determined by real-time DSA melanography during the operation.Results All the patients completed the operation successfully.Total resection of AVM was achineved in 6 patients and partial in 1 with thoracic IAVM invading the ventral side of the spinal cord.The follow up ranged from 9 months to 54 months,with an average of(27.7±16.5)months.McCormick gradeⅠwas achieved in 2 patients,gradeⅡin 2,gradeⅢin 1 and gradeⅣin 2 at 9months after surgery.At the last follow-up,the symptoms of all the patients were improved and no death occurred.Except for one patient with partial resection,MRI showed no recurrence in the other 6 patients.Conclusions IAVMs are rare in clinic.Under electrophysiological monitoring,intraoperative DSA melanography assisted microsurgical resection of IAVMs can achieve good clinical outcomes.

关 键 词：脊髓血管病 脊髓髓内动静脉畸形 显微手术 疗效 

分 类 号：R744.1[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]