Niimi Yasunari, Berenstein Alejandro, Fernandez Patricia M, Brisman Jonathan L, Song Joon K
Center for Endovascular Surgery, Hyman-Newman Institute for Neurology and Neurosurgery, Roosevelt Hospital, New York, New York 10019, USA.
J Neurosurg. 2005 Aug;103(2 Suppl):156-62. doi: 10.3171/ped.2005.103.2.0156.
The authors characterize the clinical presentation and imaging features of paraspinal nonvertebral arteriovenous fistulas (AVFs) along the segmental nerve and describe their endovascular treatment.
The authors undertook a retrospective review of medical records, imaging, and treatment of patients with endovascular problems spanning the period from 1985 to 2003. Five pediatric patients (2-3 years of age) received diagnoses of nonvertebral paraspinal AVFs along the segmental nerve. All patients presented with an incidentally discovered continuous murmur over the paraspinal or parasternal regions. All patients were neurologically intact; two patients had cardiomegaly. The AVF was found in the midthoracic level in four patients and at L-3 in one patient. All AVFs were high-flow single-hole fistulas at the neural foramen with venous drainage into paraspinal and epidural veins but without intradural reflux. All fistulas were endovascularly occluded in the same session as diagnostic angiography took place. The fistula was completely occluded, with detachable coils in one case and with N-butyl-cyanoacrylate (NBCA) in four cases. Before NBCA injection, the flow through the fistula was decreased either by placing coils distal to the fistula or by inflating a balloon proximally. No signs of recanalization appeared on short-term follow-up magnetic resonance imaging in all patients. All patients remained neurologically intact at the last available follow-up session (mean 6 years).
Nonvertebral paraspinal AVFs along the segmental nerve are specific disease entities seen in children presenting with bruit and cardiomegaly. Endovascular embolization should be the treatment of choice for this rare disease.
作者描述沿节段神经的椎旁非椎体动静脉瘘（AVF）的临床表现和影像学特征，并介绍其血管内治疗方法。
作者对1985年至2003年期间患有血管内疾病患者的病历、影像学资料及治疗情况进行回顾性分析。5例儿科患者（2至3岁）被诊断为沿节段神经的椎旁非椎体AVF。所有患者均在椎旁或胸骨旁区域偶然发现连续性杂音。所有患者神经功能均正常；2例患者有心脏扩大。4例患者的AVF位于胸段中部水平，1例患者的AVF位于L-3水平。所有AVF均为神经孔处的高流量单孔瘘，静脉血引流至椎旁和硬膜外静脉，但无硬膜内反流。所有瘘均在诊断性血管造影的同一次手术中进行血管内闭塞。1例患者用可脱性弹簧圈完全闭塞瘘，4例患者用N-丁基-氰基丙烯酸酯（NBCA）闭塞瘘。在注射NBCA之前，通过在瘘管远端放置弹簧圈或在近端充盈球囊来减少通过瘘管的血流。所有患者在短期随访磁共振成像中均未出现再通迹象。在最后一次随访时（平均6年），所有患者神经功能均保持正常。
沿节段神经的椎旁非椎体AVF是儿童中出现杂音和心脏扩大时可见的特定疾病实体。血管内栓塞应是这种罕见疾病的首选治疗方法。
