Microvascular anatomy of spinal dural arteriovenous fistulas: arteriovenous connections and their relationships with the dura mater
Microvascular anatomy of spinal dural arteriovenous fistulas: arteriovenous connections and their relationships with the dura mater
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DOI：
10.3171/2014.11.spine14786
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发表时间：
2015-10-01
影响因子：
2.8
通讯作者：
Taniguchi, Makoto
中科院分区：
文献类型：
--
作者：
Takai, Keisuke;Komori, Takashi;Taniguchi, Makoto
目的 硬脊膜动静脉瘘（AVF）的微血管解剖结构，特别是血管与硬脑膜的关系，尚未得到详细的血管造影证实和组织学证实。 方法 2012年1月至2014年4月，东京都神经内科医院共对7例胸段硬脊膜动静脉瘘患者进行了开放显微手术闭塞术。 医院。通过使用先进的微血管造影（包括 3D 计算机图形学和术中吲哚菁绿视频血管造影）以及组织学检查结果，对硬脊膜 AVF 的微血管解剖结构进行了全面评估。 结果 两种微血管造影技术充分详细地揭示了脑膜血管的空间走向和体内血流及其与硬脑膜的关系。肋间动脉的脑膜分支在邻近根套的硬脑膜外表面分裂成多个脑膜血管。穿过硬脑膜到达硬脑膜内表面后，这些血管聚集并连接成单个硬膜内引流血管。在硬脑膜内表面，单个引流血管由周围的多个脑膜血管供血，这些脑膜血管似乎是头状水母。组织学结果显示，肋间动脉脑膜分支的结构与正常动脉的结构一致。硬膜内引流血管的结构与经逆行动脉流入改变的静脉的结构相对应。在硬脑膜内表面，有超过 1 条脑膜动脉聚集并与近端根髓静脉汇合。 结论 硬脊膜 AVF 位于硬脑膜内表面，其中超过 1 条脑膜供血动脉和单个近根髓静脉之间的多个直接 AV 连接发生在静脉与硬脑膜连接的部位。
OBJECT The microvascular anatomy of spinal dural arteriovenous fistulas (AVFs), especially the relationships of the vessels with the dura mater, has yet to be angiographically demonstrated in detail and proven histologically.METHODS From January 2012 through April 2014, a total of 7 patients with spinal dural AVFs in the thoracic region underwent open microsurgical obliteration at Tokyo Metropolitan Neurological Hospital. The microvascular anatomy of spinal dural AVFs was comprehensively assessed by using advanced microangiography, including 3D computer graphics and intraoperative indocyanine green video angiography, and by histological findings.RESULTS The 2 microangiography techniques revealed the spatial course and in vivo blood flow of the meningeal vessels and their relationships with the dura mater in sufficient detail. The meningeal branch of the intercostal artery split into multiple meningeal vessels on the outer dural surface adjacent to the root sleeve. After crossing the dura mater to the inner dural surface, these vessels gathered and joined a single intradural draining vessel. On the inner dural surface, the single draining vessel was fed by the surrounding multiple meningeal vessels, which appeared to be caput medusae. Histological findings revealed that the structure of the meningeal branch of the intercostal artery corresponded to that of a normal artery. The structure of intradural draining vessels corresponded to that of a vein modified by retrograde arterial inflow. On the inner dural surface, more than 1 meningeal artery gathered and joined with the proximal radiculomedullary vein.CONCLUSIONS Spinal dural AVFs are located on the inner dural surface, where multiple direct AV connections between more than 1 meningeal feeding artery and a single proximal radiculomedullary vein occur at the site where the vein connects to the dura mater.