Hessler C, Regelsberger J, Grzyska U, Illies T, Zeumer H, Westphal M
University Hospital Hamburg-Eppendorf, Neurosurgery, Hamburg, Germany.
Cent Eur Neurosurg. 2010 Feb;71(1):8-12. doi: 10.1055/s-0029-1224195. Epub 2009 Sep 25.
Spinal dural arteriovenous fistulae (SDAVF) are rare but remain the most common type of spinal vascular malformations. Treatment options for SDAVF include endovascular embolization, microsurgical dissection or a combination of both. But the optimal treatment paradigm has yet to be defined and may well be an individualized interdisciplinary combinatorial approach.
From 1980 to 2008, 156 patients with the diagnosis of SDAVF were treated by neuroradiological and neurosurgical means. Based on the procedure-related complications we retrospectively analyzed our data to elucidate the reasons for endovascular failure and the evolution of the surgical technique.
156 patients were included in this study. There were 31 (19.9%) female and 125 (80.1%) male patients. Average age at the time of diagnosis was 60.8 years. 102 out of 156 (65.4%) underwent endovascular obliteration, 54 (34.6%) patients were treated primarily by surgery. 134 (85.9%) underwent follow-up examination. A total of 29 (18.6%) out of 156 patients could not be treated successfully by endovascular (9.4%) or surgical (4.1%) means.
Microsurgery can be recommended as the first choice treatment when the fistula's point is unmistakably identified intradurally. Endovascular obliteration may be justifiable in cases with an easy access to a monoradicular feeding artery during diagnostic angiography. Surgery is a definitive treatment with stable long-term results in which procedure-related morbidity is low. During evolution of the combined approach, endovascular coil placement for correct localization of the fistula and the use of intraoperative micro-Doppler was found to be very helpful in increasing the safety of the surgical procedure and minimizing surgical exposure.
脊髓硬脊膜动静脉瘘（SDAVF）虽罕见，但仍是最常见的脊髓血管畸形类型。SDAVF的治疗选择包括血管内栓塞、显微手术切除或两者联合。但最佳治疗模式尚未明确，很可能是个体化的多学科联合方法。
1980年至2008年，156例诊断为SDAVF的患者接受了神经放射学和神经外科治疗。基于与手术相关的并发症，我们回顾性分析数据，以阐明血管内治疗失败的原因及手术技术的发展。
本研究纳入156例患者。女性31例（19.9%），男性125例（80.1%）。诊断时的平均年龄为60.8岁。156例中的102例（65.4%）接受了血管内闭塞治疗，54例（34.6%）患者主要接受手术治疗。134例（85.9%）接受了随访检查。156例患者中共有29例（18.6%）无法通过血管内（9.4%）或手术（4.1%）方法成功治疗。
当瘘口在硬脊膜内明确识别时，显微手术可作为首选治疗方法。在诊断性血管造影时，若能轻松找到单根供血动脉，血管内闭塞术可能是合理的。手术是一种确定性治疗方法，长期效果稳定，手术相关发病率低。在联合治疗方法的发展过程中，发现血管内放置线圈以正确定位瘘口以及术中使用微型多普勒对提高手术安全性和减少手术暴露非常有帮助。
