Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02215, USA.
Neurosurg Focus. 2012 May;32(5):E3. doi: 10.3171/2012.1.FOCUS11344.
Type I spinal dural arteriovenous fistulas (SDAVFs) are low-flow vascular shunts fed by radicular arteries in patients who most often present with myelopathy. Although some fistulas are amenable to endovascular embolization, nearly all can be treated with direct microsurgical obliteration.
The authors reviewed their experience in treating 214 craniospinal arteriovenous malformations and/or fistulas over the last 8 years. Of these, 19 were spinal (9%), of which 15 (79%) were Type I SDAVFs. The authors reviewed the patients' epidemiological characteristics, presenting symptoms, and SDAVF angioarchitecture in all cases. They subsequently analyzed surgical obliteration rates and outcomes of all 11 patients who underwent fistula microsurgical obliteration.
In all patients who underwent microsurgical treatment, complete angiographic obliteration of the fistula was achieved. At follow-up, 10 (91%) of 11 patients exhibited improvement, 1 patient (9%) was the same, and no patients were worse. Specifically, 8 (73%) of 11 patients had improvement in strength and sensation, 5 (71%) of 7 had improvement of bowel/bladder function, and 3 (60%) of 5 had improvement of preoperative paresthesias. There were no wound infections, CSF leaks, or permanent neurological deficits.
Microsurgical treatment of SDAVF provides direct access to the fistula point, allowing for high obliteration rates with excellent long-term improvement of preoperative deficits and limited periprocedural complications.
I 型脊髓硬脊膜动静脉瘘（SDAVF）是一种低流量血管分流，由神经根动脉供血，患者常表现为脊髓病。虽然有些瘘管可以通过血管内栓塞治疗，但几乎所有的瘘管都可以通过直接显微镜下闭塞治疗。
作者回顾了他们在过去 8 年中治疗的 214 例颅脊髓动静脉畸形和/或瘘管的经验。其中 19 例为脊髓病变（9%），其中 15 例（79%）为 I 型 SDAVF。作者回顾了所有患者的流行病学特征、临床表现和 SDAVF 血管造影结构。随后，他们分析了所有 11 例行瘘管显微镜下闭塞治疗患者的手术闭塞率和结果。
在所有接受显微镜治疗的患者中，瘘管的完全血管造影闭塞均得以实现。在随访中，11 例患者中有 10 例（91%）症状改善，1 例（9%）无变化，没有患者症状恶化。具体而言，11 例患者中有 8 例（73%）肌力和感觉改善，7 例患者中有 5 例（71%）肠/膀胱功能改善，5 例患者中有 3 例（60%）术前感觉异常改善。无伤口感染、CSF 漏或永久性神经功能缺损。
SDAVF 的显微镜治疗提供了直接到达瘘口的途径，可实现高闭塞率，长期改善术前缺陷，围手术期并发症有限。
