Departments of Radiology.
AJNR Am J Neuroradiol. 2013 Oct;34(10):1974-9. doi: 10.3174/ajnr.A3522. Epub 2013 Apr 25.
Spinal dural arteriovenous fistulas are a rare entity that, if left untreated, can lead to considerable morbidity with progressive spinal cord symptoms. The aim of this study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas that were primarily treated with endovascular embolization.
A retrospective review was performed of all patients from 1997-2010 who underwent treatment at 2 academic referral centers for a spinal dural arteriovenous fistula. Follow-up was performed by clinical examination, and functional status was measured by use of the Aminoff-Logue Disability Scale, McCormick classification grading, and mRS scores. The nonparametric Wilcoxon signed rank test was used to compare pretreatment and posttreatment Aminoff-Logue Disability Scale gait and micturition scores, McCormick classification grading, and mRS scores. P values < .05 were considered significant.
A total of 38 patients were included. Five patients (2 endovascular, 3 surgical) were lost to follow-up and therefore were excluded from the analysis, 29 patients were initially treated from an endovascular approach (9 Onyx, 20 cyanoacrylate), and 4 patients were treated from a standard surgical approach. Five patients in the endovascular group subsequently underwent surgery for various reasons. The clinical improvements in the Aminoff-Logue Disability Scale gait and micturition scores, McCormick classification grading, and the mRS scores were statistically significant (P < .05, Wilcoxon signed rank test).
We conclude that endovascular treatment of spinal dural arteriovenous fistulas can result in good clinical outcomes. Surgery remains the treatment of choice when safe embolization of the proximal radicular draining vein cannot be obtained or because the shunting artery of the spinal dural arteriovenous fistula also supplies the anterior spinal, posterior spinal, or a radiculomedullary artery.
脊髓硬脊膜动静脉瘘是一种罕见的疾病，如果不进行治疗，可能会导致进行性脊髓症状，从而产生相当大的发病率。本研究的目的是评估主要通过血管内栓塞治疗的脊髓硬脊膜动静脉瘘患者的临床结果。
对 1997 年至 2010 年在 2 个学术转诊中心接受治疗的所有脊髓硬脊膜动静脉瘘患者进行回顾性研究。通过临床检查进行随访，使用 Aminoff-Logue 残疾量表、McCormick 分级和 mRS 评分来衡量功能状态。采用非参数 Wilcoxon 符号秩检验比较治疗前后 Aminoff-Logue 残疾量表步态和排尿评分、McCormick 分级和 mRS 评分。P 值<0.05 被认为有统计学意义。
共纳入 38 例患者。5 例患者（2 例血管内，3 例手术）失访，因此被排除在分析之外，29 例患者最初采用血管内方法治疗（9 例 Onyx，20 例氰基丙烯酸酯），4 例患者采用标准手术方法治疗。血管内组中有 5 例患者因各种原因随后接受了手术。Aminoff-Logue 残疾量表步态和排尿评分、McCormick 分级和 mRS 评分的临床改善具有统计学意义（P<0.05，Wilcoxon 符号秩检验）。
我们得出结论，血管内治疗脊髓硬脊膜动静脉瘘可以获得良好的临床结果。当无法安全栓塞近端神经根引流静脉或脊髓硬脊膜动静脉瘘的分流动脉也供应前脊髓、后脊髓或神经根脊髓动脉时，手术仍然是首选治疗方法。
