Results of the surgical treatment of perimedullary arteriovenous fistulas with special reference to embolization
Results of the surgical treatment of perimedullary arteriovenous fistulas with special reference to embolization
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髓周动静脉瘘特别是栓塞手术治疗的结果
DOI：
10.3171/spi.1999.90.2.0198
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发表时间：
1999
影响因子：
4.1
通讯作者：
H. Abe
中科院分区：
文献类型：
--
作者：
K. Hida;Y. Iwasaki;K. Goto;K. Miyasaka;H. Abe
目的。这项回顾性研究旨在评估手术治疗和术前栓塞治疗髓周动静脉瘘（AVF）患者的效果。方法。作者研究了连续 20 名接受手术治疗的髓周 AVF 患者。 5 名患者的动静脉分流部位位于颈椎水平，12 名患者的动静脉分流部位位于胸椎水平，3 名患者的动静脉分流部位位于髓圆锥水平。在 20 个 AVF 中，3 个仅由脊髓前动脉供血，3 个由脊髓后动脉供血，14 个由脊髓前动脉和脊髓后动脉供血。九名患者患有静脉曲张，压迫脊髓。 11 例患者接受了手术，9 例患者接受了手术联合术前辅助栓塞治疗。术前栓塞显着减少了通过 AVF 的血流量，并有利于随后的手术过程。术后血管造影显示 16 名患者的 AVF 完全消失。然而，其他四名患者的小瘘管仍然存在，其大病变由脊髓前动脉供血。术后，11 名患者的神经功能状态得到改善，8 名患者没有变化，1 名患者的神经功能状态更差。结论。在所有病例中，即使脊髓前动脉受累，也可以通过手术有效阻断脊髓动静脉分流。对于大且高流量的 AVF，栓塞被证明是手术的有用辅助手段。
Object. This retrospective study was performed to evaluate the results of surgical treatment and the use of preoperative embolization in managing patients with perimedullary arteriovenous fistulas (AVFs). Methods. The authors studied 20 consecutive patients with perimedullary AVFs who underwent surgical treatment. Arteriovenous shunts were at the level of the cervical spine in five patients, the thoracic spine in 12, and the conus medullaris in three patients. Of the 20 AVFs, three were fed by the anterior spinal artery only, three by the posterior spinal artery, and 14 by both the anterior and posterior spinal arteries. Nine patients had varices that compressed the spinal cord. Eleven patients underwent surgery, and nine patients underwent surgery combined with adjuvant preoperative embolization. Preoperative embolization remarkably reduced blood flow through the AVFs and facilitated subsequent surgical procedures. Postoperative angiography revealed complete disappearance of the AVFs in 16 patients. However, small fistulas persisted in the other four patients, whose large lesions were fed by the anterior spinal artery. Postoperatively, neurological status was improved in 11 patients, unchanged in eight, and worse in one patient. Conclusions. Effective interruption of a spinal arteriovenous shunt was achieved by surgery in all cases, even when the anterior spinal artery was involved. For large and high-flow AVFs, embolization proved to be a useful adjunct to surgery.