[A case of spinal dural arteriovenous fistula draining to the ventral coronal venous plexus].
[A case of spinal dural arteriovenous fistula draining to the ventral coronal venous plexus].
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硬脊膜动静脉瘘引流至腹侧冠状静脉丛1例[J].
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
K. Sano
中科院分区：
文献类型：
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作者：
Masanori Yoshino;M. Kohno;S. Kanayama;H. Yazaki;H. Segawa;I. Saito;K. Sano
在此我们报告一个引流至脊髓前静脉的硬脊膜动静脉瘘管病例。一位80岁女性因下肢进行性无力而就诊。MRI显示Th 10至L1脊髓扩大，T2加权像上呈高信号，脊髓背侧和腹侧表面有多个流空。左侧L2腰动脉的血管造影显示一个发夹形血管，具有升支和降支，模仿延髓根动脉。左侧L2腰动脉的斜位血管造影显示，根髓静脉引流至扩张的脊髓前静脉，然后在脊髓的前后表面向颅侧和尾侧引流。患者接受了T9-L2椎板切除术。在蛛网膜下腔发现了几条大的弯曲扩张的静脉。检查硬膜的内表面发现了一条动脉化的静脉，始于L2水平，向上走行。动脉化静脉凝固并中断。术后血管造影显示瘘口闭塞。术后MRI恢复正常，T2高信号完全消失，脊髓增粗。在大多数硬脊膜动静脉瘘中，静脉引流主要在脊髓后表面向上。引流至脊髓前静脉的硬脊膜动静脉瘘不典型，导致难以区分脊髓前动脉和脊髓前静脉。斜位造影有助于鉴别脊髓前静脉和脊髓前动脉。
Here we report a case of spinal dural areteriovenous fistula (AVF) draining to the anterior spinal vein. An 80-year-old female presented with progressive weakness of lower extremities. MRI showed spinal enlargement at the Th10 to L1 with high intensity signals on T2-weighted image and multiple flow voids on the dorsal and ventral surface of the spinal cord. Angiogram of the left L2 lumbar artery demonstrated a hairpin-shaped vessel with ascending and descending limbs, mimicking radiculomedullary artery. Oblique view angiogram of the left L2 lumbar artery showed that radiculomedullary vein drained to the dilated anterior spinal vein, which then drained cranially and caudally on the anterior and posterior surface of the spinal cord. The patient underwent T9-L2 laminectomy. Several large tortuous dilated veins in the subarachnoid space were found. Examination of the inner surface of the dura revealed an arterialized vein that began at the level of L2 and coursed superiorly. The arterialized vein was coagulated and interrupted. The postoperative angiogram demonstrated the obliteration of the fistula. Postoperative MRI returned to normal with complete disappearance of T2 high signal, cord enlargement. In most spinal dural AVF, the venous drainage is predominantly upward on the posterior surface of the spinal cord. The spinal dural AVF draining to the anterior spinal vein is atypical, and cause difficulty in differentiating the anterior spinal artery from the anterior spinal vein. Oblique view angiogram may be helpful to differentiate the anterior spinal vein from anterior spinal artery.