Pulido Rivas P, Villoria Medina F, Fortea Gil F, Sola R G
Hospital Universitario Niño Jesus, Madrid, España.
Rev Neurol. 2004;38(5):438-42.
Spinal dural fistulas consist in an artery that penetrates into the dura mater and drains into a perispinal vein. They are most commonly located in the dorsal or lumbar region; a craniocervical position is infrequent. The clinical features presented by these patients involve an progressive ascending myelopathy caused by severe venous hypertension, although they can also start with symptoms of a subarachnoid haemorrhage.
A 62 year old male with symptoms of progressive myelopathy due to a dural fistula dependent on meningeal branches of the right PICA, which was treated surgically by fistula clipping performed using an extreme lateral suboccipital approach. In the literature that was reviewed there were 35 cases of dural fistulas located at the craniocervical junction.
The existence of clinical features compatible with cervical myelopathy and an anodyne cervical resonance justify the need to perform medullar arteriography owing to a suspected vascular malformation. An early diagnosis of a dural fistula and its proper treatment lead to a diminished morbidity and mortality rate in these patients.
脊髓硬脊膜动静脉瘘是指一条动脉穿入硬脊膜并引流至脊髓周围静脉。它们最常位于背部或腰部区域；颅颈位置较少见。这些患者的临床特征包括由严重静脉高压引起的进行性上升性脊髓病，尽管也可能以蛛网膜下腔出血症状起病。
一名62岁男性因依赖右侧小脑后下动脉脑膜支的硬脊膜动静脉瘘出现进行性脊髓病症状，采用枕下极外侧入路进行瘘管夹闭手术治疗。在所查阅的文献中，有35例硬脊膜动静脉瘘位于颅颈交界处。
存在与颈髓病相符的临床特征以及无异常的颈椎磁共振成像，因怀疑血管畸形而有必要进行脊髓血管造影。硬脊膜动静脉瘘的早期诊断及其恰当治疗可降低这些患者的发病率和死亡率。
