Oldfield Edward H, Bennett Andrew, Chen Michael Y, Doppman John L
Surgical Neurology Branch and Department of Radiology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1414, USA.
J Neurosurg. 2002 Mar;96(2 Suppl):220-9. doi: 10.3171/spi.2002.96.2.0220.
Spinal dural arteriovenous fistulas (AVFs) frequently cause progressive myelopathy. When they are localized by imaging studies, surgery can be safely performed by simply interrupting the vein draining the fistula intradurally, and the results will be excellent and lasting. In some patients with clinical features of a spinal dural AVF and in whom magnetic resonance imaging and/or myelography findings are consistent with a diagnosis of a spinal dural AVF, however, spinal arteriography demonstrates no such results. The authors used a simple strategy based on knowledge of the epidemiology, pathophysiology, and anatomy of spinal dural AVFs to manage these cases successfully. In two patients, atherosclerotic occlusion was the primary cause for the failure of arteriography to visualize the dural AVF. The presence of an aortic aneurysm was an additional contributing factor preventing arteriographic visualization in one of these patients. In a third patient, massive obesity, and aortic atheroslerosis and tortuosity contributed to the absence of findings on three spinal arteriograms before surgical exploration lead to a more focused arteriographic examination that was successful.
脊髓硬脊膜动静脉瘘（AVF）常导致进行性脊髓病。当通过影像学检查定位后，只需在硬膜内阻断引流瘘口的静脉，即可安全地进行手术，且效果良好且持久。然而，在一些具有脊髓硬脊膜AVF临床特征且磁共振成像和/或脊髓造影结果与脊髓硬脊膜AVF诊断相符的患者中，脊髓血管造影却未显示出此类结果。作者基于对脊髓硬脊膜AVF的流行病学、病理生理学和解剖学的了解，采用了一种简单的策略成功处理了这些病例。在两名患者中，动脉粥样硬化闭塞是血管造影未能显示硬脊膜AVF的主要原因。其中一名患者存在主动脉瘤是妨碍血管造影显示的另一个因素。在第三名患者中，严重肥胖、主动脉粥样硬化和迂曲导致在手术探查前的三次脊髓血管造影均未发现异常，随后进行了更有针对性的血管造影检查并取得成功。
