Hida K, Iwasaki Y, Goto K, Miyasaka K, Abe H
Department of Neurosurgery, University of Hokkaido, Sapporo, Japan.
J Neurosurg. 1999 Apr;90(2 Suppl):198-205. doi: 10.3171/spi.1999.90.2.0198.
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).
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.
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.
进行这项回顾性研究以评估手术治疗结果以及术前栓塞在治疗髓周动静脉瘘（AVF）患者中的应用。
作者研究了连续20例接受手术治疗的髓周AVF患者。动静脉分流位于颈椎水平的有5例，胸椎水平的有12例，圆锥水平的有3例。在这20例AVF中，3例仅由脊髓前动脉供血，3例由脊髓后动脉供血，14例由脊髓前动脉和脊髓后动脉共同供血。9例患者有压迫脊髓的静脉曲张。11例患者接受了手术，9例患者接受了手术联合辅助性术前栓塞。术前栓塞显著减少了通过AVF的血流量并便于后续手术操作。术后血管造影显示16例患者的AVF完全消失。然而，其他4例患者仍存在小瘘口，其大的病变由脊髓前动脉供血。术后，11例患者神经状态改善，8例不变，1例恶化。
即使累及脊髓前动脉，手术在所有病例中均有效中断了脊髓动静脉分流。对于大的高流量AVF，栓塞被证明是手术的有用辅助手段。
