Department of Neurosurgery, University of Tennessee Health Science Center and Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee 38120, USA.
J Neurosurg Spine. 2012 Sep;17(3):251-5. doi: 10.3171/2012.6.SPINE11835. Epub 2012 Jul 6.
Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations. Type 1 spinal arteriovenous malformations are defined by the presence of radiculomeningeal feeders that drain into intradural veins. Patients with these lesions frequently present with chronic myelopathy, which is most often caused by venous hypertension. The authors present the case of a 69-year-old man with acute paraparesis following a lumbar epidural injection, resulting from a previously undiagnosed SDAVF. The patient initially reported right lower-extremity weakness and paresthesias and was referred to an orthopedic practice. His pain and weakness were exacerbated with ambulation. Reevaluation at 4 months was remarkable for groin, mild low-back, and buttock pain. The patient received a right L5-S1 interlaminar epidural steroid injection and became acutely weak. He presented to the emergency department 3 hours after the injection. Once MRI of the lumbar and thoracic spine had been performed, the neurosurgery service was consulted, and it was decided to proceed with emergent spinal angiography with the intent to embolize the fistula. An emergent spinal angiogram was obtained, revealing 2 arterial pedicles emanating from the right T-5 and T-6 radicular arteries. Transarterial embolization was thought to be the most rapid way to potentially obliterate the fistula. The patient exhibited immediate improvement in neurological function, and by 6 hours postprocedure, his neurological function was near normal. He was ambulatory and released to home 3 days after the embolization procedure.
脊髓硬膜动静脉瘘（SDAVF）是最常见的脊髓动静脉畸形类型。1 型脊髓动静脉畸形的定义是存在神经根脑膜供血动脉，这些供血动脉引流到硬膜内静脉中。这些病变的患者常出现慢性脊髓病，其最常见的原因是静脉高压。作者报告了一例 69 岁男性患者，在腰椎硬膜外注射后出现急性截瘫，这是由于先前未诊断出的 SDAVF 引起的。患者最初报告右下肢无力和感觉异常，并被转至骨科就诊。他的疼痛和无力在行走时加重。4 个月时的重新评估显示腹股沟、轻度下腰痛和臀部疼痛。患者接受了右侧 L5-S1 椎间孔硬膜外类固醇注射，突然变得非常虚弱。他在注射后 3 小时到急诊科就诊。一旦进行了腰椎和胸椎 MRI 检查，就咨询了神经外科服务，并决定进行紧急脊髓血管造影以栓塞瘘管。进行了紧急脊髓血管造影，显示有 2 个动脉蒂发自右侧 T-5 和 T-6 神经根动脉。经动脉栓塞被认为是最快速的潜在闭塞瘘管的方法。患者的神经功能立即得到改善，在手术后 6 小时，他的神经功能几乎恢复正常。他能够行走，并在栓塞手术后 3 天出院回家。
