Ye Feng, You Chao, He Min, Li Jin, Jia Lu, Liu Yi, Zhang Yu
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Zhonghua Wai Ke Za Zhi. 2010 Apr 15;48(8):585-8.
To evaluate efficacy of microsurgical hemilaminectomy approach and use of intraoperative indocyanine green videoangiography for patients with intradural dorsal arteriovenous fistula.
Medical records and follow-up data of 24 patients who were microsurgically treated at a single institution for intradural dorsal arteriovenous fistula between January 2004 and August 2008 were retrospectively reviewed. Preoperatively DSA was performed for definite diagnosis. All patients were evaluated with the Aminoff and Logue scale. Preoperative, 4 patients had excellent spinal condition having mean score of 1.0; 8 cases had good spinal condition with mean score of 3.4; 9 cases had average spinal condition with mean score of 6.9; 3 cases had poor spinal condition with mean score of 10.0. Twenty two cases had one feeder while 2 cases had two feeding arteries. All the patients underwent microsurgical hemilaminectomy via a posterior approach. Two patients received complemented surgery because of the recurrence of the lesion after embolisation failed. Three patients received intraoperative indocyanine green videoangiography. Combined followed-up imaging and myelonic function were used for evaluating followed-up data.
Mean follow up was done up to 36 months. Followed-up imaging didn't reveal any residual lesion or its recurrence. Spinal functional assessment using Aminoff and Logue scale showed 16 patients of excellent outcome and had mean score of 0.7; 4 had good outcome having mean score of 4.8; 3 was of average nature with mean score of 6.7; 1 had poor outcome with 9.0 scores. With the surgical treatment, 16 cases were cured, 6 were improved and 2 cases had no change according to synthetic curative effect.
Microsurgical treatment, especially the microsurgical hemilaminectomy via a posterior approach, is effective treatment intradural dorsal arteriovenous fistula. Intraoperative indocyanine green videoangiography is a simple auxiliary tool for intraoperative quality control and favorable surgical outcomes.
评估显微外科半椎板切除术及术中吲哚菁绿血管造影术在硬脊膜内背侧动静脉瘘患者中的疗效。
回顾性分析2004年1月至2008年8月在单一机构接受显微外科治疗的24例硬脊膜内背侧动静脉瘘患者的病历和随访数据。术前进行DSA以明确诊断。所有患者均采用Aminoff和Logue量表进行评估。术前，4例患者脊髓状况极佳，平均评分为1.0；8例患者脊髓状况良好，平均评分为3.4；9例患者脊髓状况一般，平均评分为6.9；3例患者脊髓状况较差，平均评分为10.0。22例患者有1条供血动脉，2例患者有2条供血动脉。所有患者均通过后路进行显微外科半椎板切除术。2例患者因栓塞失败后病变复发而接受了补充手术。3例患者接受了术中吲哚菁绿血管造影术。采用联合随访影像学和脊髓功能评估随访数据。
平均随访36个月。随访影像学检查未发现任何残留病变或复发。使用Aminoff和Logue量表进行的脊髓功能评估显示，16例患者预后极佳，平均评分为0.7；4例患者预后良好，平均评分为4.8；3例患者预后一般，平均评分为6.7；1例患者预后较差，评分为9.0。根据综合疗效，手术治疗后，16例治愈，6例改善，2例无变化。
显微外科治疗，尤其是后路显微外科半椎板切除术，是治疗硬脊膜内背侧动静脉瘘的有效方法。术中吲哚菁绿血管造影术是术中质量控制和良好手术效果的简单辅助工具。
