Xia Yingpeng, Ishii Ken, Nakamura Masaya, Onozuka Satoshi, Ueda Ryo, Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki
Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Spinal Disord Tech. 2007 Aug;20(6):442-8. doi: 10.1097/bsd.0b013e318031afa1.
Retrospective study of patients with spinal arteriovenous fistula (AVF) who underwent surgical treatment.
To evaluate the validity of the intraoperative angiography (IA) for the surgical treatment of spinal AVF.
Owing to the development of interventional techniques, endovascular embolization has become the treatment of choice for AVF, but it is not applicable for every spinal AVF owing to anatomic complexity of the spinal cord vessels. To get effective occlusion of the AVF, IA has been routinely used in the management of cerebral vascular diseases, but report of its use for spinal AVF is rare.
Since 2004, 4 consecutive cases of spinal AVF (3 males and 1 female, 3 thoracic, and 1 thoracolumbar) were involved in this study. The mean age at the time of operation was 62.3 years (range from 48 to 76 y). Types of AVFs and surgical techniques were reviewed retrospectively and the outcomes were assessed using the Japanese Orthopedic Association scoring system.
AVFs in 3 patients were diagnosed as the dural type and that in the remaining patient as the perimedullary type; all feeding arteries were derived from the ninth to 10th intercostal arteries. Preoperative angiography demonstrated that the feeding arteries in 2 patients with a dural AVF were the branches of Adamkiewicz artery and in another dural AVF case, the Adamkiewicz artery could not be determined, therefore, endovascular embolization was not feasible. Including a patient with perimedullary AVF, a microsurgical clipping combined with IA was selected as the treatment. Complete occlusion of the fistula was achieved in all cases, the mean preoperative Japanese Orthopedic Association score of 4.5 improved to 6 at the final follow-up, and no perioperative complications were observed during the follow-up period.
The favorable clinical results in our spinal AVF cases confirmed that IA ensures safe and accurate occlusion of the fistula. This technique provides satisfactory surgical results for spinal AVFs.
对接受手术治疗的脊髓动静脉瘘（AVF）患者进行回顾性研究。
评估术中血管造影（IA）在脊髓AVF手术治疗中的有效性。
由于介入技术的发展，血管内栓塞已成为AVF的首选治疗方法，但由于脊髓血管解剖结构复杂，并非所有脊髓AVF都适用。为有效闭塞AVF，IA已常规用于脑血管疾病的治疗，但用于脊髓AVF的报道很少。
自2004年起，本研究纳入4例连续的脊髓AVF患者（3例男性，1例女性；3例为胸段，1例为胸腰段）。手术时的平均年龄为62.3岁（范围48至76岁）。回顾性分析AVF的类型和手术技术，并使用日本骨科协会评分系统评估结果。
3例患者的AVF被诊断为硬脊膜型，其余1例为髓周型；所有供血动脉均来自第9至第10肋间动脉。术前血管造影显示，2例硬脊膜型AVF患者的供血动脉为Adamkiewicz动脉的分支，另1例硬脊膜型AVF患者无法确定Adamkiewicz动脉，因此血管内栓塞不可行。包括1例髓周型AVF患者，选择显微手术夹闭联合IA作为治疗方法。所有病例均实现瘘管完全闭塞，术前日本骨科协会平均评分为4.5分，末次随访时提高至6分，随访期间未观察到围手术期并发症。
我们脊髓AVF病例的良好临床结果证实，IA可确保安全、准确地闭塞瘘管。该技术为脊髓AVF提供了满意的手术效果。
