术中脊髓血管造影辅助显微外科手术治疗硬脊膜动静脉瘘的疗效观察  

Efficacy of intraoperative spinal angiography-assisted microsurgery in the treatment of dural arteriovenous fistula

作　　者：盛斌 戴嵬 吴凌云 杨咏波[1] 高永月 李伟 杭春华 Sheng Bin;Dai Wei;Wu Lingyun;Yang Yongbo;Gao Yongyue;Li Wei;Hang Chunhua(Department of Neurosurgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Neurosurgical Institute of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京大学神经外科研究所,南京210008

出　　处：《中华神经外科杂志》2023年第9期887-891,共5页Chinese Journal of Neurosurgery

基　　金：南京鼓楼医院临床研究项目(2022-LCYJ-PY-38,2022-LCYJ-MS-37)。

摘　　要：目的观察术中脊髓血管造影辅助显微外科手术治疗硬脊膜动静脉瘘(SDAVF)的临床疗效。方法回顾性分析2018年1月至2021年12月南京大学医学院附属鼓楼医院神经外科连续收治的SDAVF患者,共47例。所有患者均于术中行脊髓血管数字减影血管造影(DSA),确定供血动脉来源、瘘口位置、引流静脉等后,采用电凝方法切除瘘口。术中采用吲哚菁绿荧光造影和DSA评估SDAVF治疗情况。采用改良Aminoff-Logue评分(mALS)标准评估脊髓功能的改善情况。结果47例患者均顺利完成手术。术中未出现脊髓血管造影相关的并发症,无一例患者误伤脊髓血管及瘘口残留。术后随访(10.8±4.3)个月(3~24个月)。至末次随访,症状改善41例,未改善5例,加重1例;术后随访mALS中位数为2分(1~3分),与术前的3分(2~4分)比较,差异有统计学意义(P<0.001)。病程>12个月的16例患者中,5例mALS未改善;病程>6~12个月的27例患者中,1例mALS未改善;病程为0~6个月的4例患者mALS均改善,差异有统计学意义(P=0.024)。CT血管成像或MR血管成像随访未见病变残留或复发。结论术中脊髓血管造影辅助显微外科手术治疗SDAVF安全、有效。SDAVF病程长可能影响患者术后症状的改善。Objective To observe the clinical efficacy of intraoperative spinal angiography-assisted microsurgery in the treatment of spinal dural arteriovenous fistula(SDAVF).Methods A total of 47 SDAVF patients who were admitted to the Department of Neurosurgery,Nanjing Drum Tower Hospital Affiliated of Nanjing University School of Medicine from January 2018 to December 2021 were retrospectively enrolled into this study.All patients underwent digital subtraction angiography(DSA)of spinal cord vessels during the operation to determine the source of the supplying artery,location of the fistula,and draining vein,et al.The fistulas were resected by electrocoagulation.Indocyanine green fluorescein contrast and DSA were used to evaluate the treatment of SDAVF during operation.The spinal cord function was assessed by the modified Aminoff-Logue score(mALS).Results All 47 patients underwent the operations successfully.No complications related to spinal cord angiography occurred during the operation,and there was no accidental injury of spinal cord vessels or residual fistula.The postoperative follow-up period was 10.8±4.3 months(3-24 months).Symptoms were improved in 41 cases,not improved in 5 cases,and aggravated in 1 case.The median value of mALS at postoperative follow-up was 2(1-3)points,which,compared with the preoperative score of 3(2-4)points,was significantly different(P<0.001).Of the 16 patients with a disease course>12 months,5 showed no improvement of mALS;among the 27 patients with a disease duration of 6 to 12 months,1 patient reported no improvement of mALS;all 4 patients with a disease course of 0 to 6 months reported improvement of mALS;the difference was statistically significant(P=0.024).CT angiography or MR angiography follow-up showed no residual or recurrence of lesions.Conclusions Intraoperative spinal cord angiography-assisted microsurgery is safe and effective in the treatment of SDAVF.A long course of SDAVF may affect the improvement of patients′postoperative symptoms.

关 键 词：硬脊膜动静脉瘘 神经外科手术 血管造影术 数字减影 预后 

分 类 号：R651.2[医药卫生—外科学]