Department of Neurosurgery, Clinico San Carlos University Hospital, 28040 Madrid, Spain.
Acta Neurochir (Wien). 2009 Nov;151(11):1385-97. doi: 10.1007/s00701-009-0439-6. Epub 2009 Jul 18.
Spinal dural arteriovenous fistula (SDAVF) is a rare and enigmatic disease. Functional outcome is particularly uncertain for the small group of patients that are unable to stand at the time of diagnosis (grade 5 gait disturbance on the Aminoff-Logue scale, ALS). The objective of this study is to examine the final functional outcome of patients with SDAVF in grade 5 gait ALS before treatment.
We conducted a PubMed search using the keyword "spinal dural arteriovenous fistula." A review of the clinical series and single well-detailed case reports of SDAVF gathered 106 patients with grade 5 gait ALS on the initial examination. Additionally, we report the case of a 56-year-old man presenting acute paraplegia and urinary retention on admission who had complained of sporadic motor and sphincter disturbances for 1 year. Spine T2-weighted MR imaging showed a central hyperintensity within the spinal cord, and the angiography demonstrated a T-11 SDAVF. Interruption of the fistula was performed through an urgent one-level laminectomy.
Grade 5 gait ALS was present in 25% of the patients with SDAVF included in the clinical series. Latest follow-up showed that gait disturbance improved in 73% of patients after treatment, although less than 6% became grade 1 gait ALS. Micturition disturbances improved in 39%. Exploration of our patient showed improvement to grade 1 gait ALS 1 year after the surgical treatment.
Interruption of SDAVF in paraplegic patients may improve the final functional gait outcome in some cases. No complete recovery (grade 0 gait ALS) was achieved after treatment. Micturition disturbances had a worse prognosis than motor deficits.
脊髓硬膜动静脉瘘（SDAVF）是一种罕见且神秘的疾病。对于那些在诊断时无法站立的小部分患者（Aminoff-Logue 量表上的 5 级步态障碍，ALS），其功能预后尤其不确定。本研究的目的是检查治疗前 ALS 5 级步态障碍的 SDAVF 患者的最终功能预后。
我们使用关键字“spinal dural arteriovenous fistula”在 PubMed 上进行了搜索。对 SDAVF 的临床系列和单个详细病例报告进行了回顾，共收集到 106 例初始检查时患有 5 级步态 ALS 的患者。此外，我们报告了一例 56 岁男性的病例，该患者入院时出现急性截瘫和尿潴留，1 年来一直抱怨间歇性运动和括约肌障碍。脊柱 T2 加权磁共振成像显示脊髓内中央高信号，血管造影显示 T11 硬膜动静脉瘘。通过紧急的 1 级椎板切除术来阻断瘘管。
纳入临床系列的 SDAVF 患者中，有 25%存在 5 级步态 ALS。最新随访显示，治疗后 73%的患者步态障碍得到改善，尽管不到 6%的患者步态改善至 1 级。排尿障碍改善了 39%。对我们的患者进行研究发现，手术后 1 年步态改善至 1 级。
在截瘫患者中阻断 SDAVF 可能会改善某些情况下的最终功能步态预后。治疗后没有完全恢复（0 级步态 ALS）。排尿障碍的预后比运动缺陷差。
