伴有硬膜外引流的椎旁动静脉畸形：临床谱、影像学特征及治疗结果
Paravertebral arteriovenous malformations with epidural drainage: clinical spectrum, imaging features, and results of treatment.
作者信息
Goyal M, Willinsky R, Montanera W, terBrugge K
机构信息
Department of Medical Imaging, the Toronto Hospital, Western Division, University of Toronto, Ontario, Canada.
出版信息
AJNR Am J Neuroradiol. 1999 May;20(5):749-55.
BACKGROUND AND PURPOSE
Arteriovenous malformations (AVMs) of the spine or spinal cord can be characterized as spinal cord AVMs, spinal cord and dural arteriovenous fistulas, and AVMs occurring outside the dura but draining into the epidural veins. The purpose of this study was to review the clinical spectrum, imaging features, and results of treatment of paravertebral arteriovenous malformations (PVAVMs) with epidural drainage.
METHODS
The clinical records and images of 10 patients with PVAVMs were analyzed retrospectively for clinical presentation, MR findings, angioarchitecture, pathophysiology, treatment efficacy, and clinical follow-up.
RESULTS
Seven patients had myelopathy. The MR findings for three of these patients showed spinal cord hyperintensity on T2-weighted sequences and prominent perimedullary vessels. Angiography, performed in two of the three patients, showed evidence of reflux into the perimedullary veins from the PVAVMs. Each of these two patients underwent surgical clipping of the radicular vein leading to the perimedullary veins. In three of the seven patients, there were large epidural veins compressing the cord. Angiography performed in these patients showed large PVAVMs with multiple feeders, which were treated by a combination of transarterial and transvenous embolization. One of the seven patients had an associated spinal cord arteriovenous malformation. In three patients with incidental PVAVMs, cure was achieved by using a combination of coils and liquid adhesives by the endovascular route.
CONCLUSION
The clinical presentation of PVAVMs is variable, and symptomatic lesions are the result of compression by epidural veins or of congestive myelopathy. A clear understanding of the anatomy and pathophysiology is necessary to plan treatment. Endovascular techniques are capable of curing the malformation, alleviating the symptoms, or both in a significant proportion of these lesions.
背景与目的
脊柱或脊髓的动静脉畸形（AVM）可分为脊髓AVM、脊髓和硬脊膜动静脉瘘以及发生在硬脊膜外但引流至硬膜外静脉的AVM。本研究的目的是回顾经硬膜外引流的椎旁动静脉畸形（PVAVM）的临床谱、影像学特征及治疗结果。
方法
回顾性分析10例PVAVM患者的临床记录和影像资料，分析临床表现、磁共振成像（MR）表现、血管构筑、病理生理、治疗效果及临床随访情况。
结果
7例患者出现脊髓病。其中3例患者的MR表现为T2加权序列上脊髓高信号及髓周血管明显。3例患者中的2例进行了血管造影，显示有从PVAVM反流至髓周静脉的证据。这2例患者均接受了导致髓周静脉的根静脉手术夹闭。7例患者中的3例有大的硬膜外静脉压迫脊髓。这些患者的血管造影显示有多个供血支的大PVAVM，采用经动脉和经静脉栓塞联合治疗。7例患者中有1例合并脊髓动静脉畸形。3例偶然发现PVAVM的患者通过血管内途径联合使用弹簧圈和液体黏合剂实现了治愈。
结论
PVAVM的临床表现多样，有症状的病变是硬膜外静脉压迫或充血性脊髓病的结果。规划治疗时需要清楚了解解剖结构和病理生理。血管内技术能够在相当一部分此类病变中治愈畸形、缓解症状或二者兼具。
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