Department of Neurosurgery, Niigata Neurosurgical Hospital, Yamada, Niigata; and.
J Neurosurg Spine. 2014 Mar;20(3):256-64. doi: 10.3171/2013.11.SPINE13402. Epub 2014 Jan 17.
The authors previously reported a case of complex arteriovenous fistula (AVF) at C-1 with multiple dural and spinal feeders that were linked with a common medullary venous channel. The purpose of the present study was to collect similar cases and analyze their angioarchitecture to gain a better understanding of this malformation.
Three such cases, affecting 2 males and 1 female in their 60s who had presented with hematomyelia (2) or progressive myelopathy (1), were treated surgically, and the operative findings from all 3 cases were compared using digital subtraction angiography (DSA) to determine the angioarchitecture.
The C-1 and C-2 radicular arteries and anterior and posterior spinal arteries supplied feeders to a single medullary draining vein in various combinations and via various routes. The drainage veins ran along the affected ventral nerve roots and lay ventral to the spinal cord. The sites of shunting to the vein were multiple: dural, along the ventral nerve root in the subarachnoid space, and on the spinal cord, showing a vascular structure typical of dural AVF, that is, a direct arteriovenous shunt near the spinal root sleeve fed by one or more dural arteries and ending in a single draining vein, except for intradural shunts fed by feeders from the spinal arteries. In 2 cases with hemorrhagic onset the drainer flowed rostrally, and in 1 case associated with congestive myelopathy the drainer flowed both rostrally and caudally. Preoperative determination of the shunt sites and feeding arteries was difficult because of complex recruitment of the feeders and multiple shunt sites. The angioarchitecture in these cases was clarified postoperatively by meticulous comparison of the DSA images and operative video. Direct surgical intervention led to a favorable outcome in all 3 cases.
A high cervical complex AVF has unique angioarchitectural characteristics different from those seen in the other spinal regions.
作者先前报道了一例 C1 处伴有多个硬脑膜和脊髓供血动脉且与共同的髓内静脉通道相连的复杂动静脉瘘（AVF）病例。本研究的目的是收集类似病例并分析其血管构筑结构，以更好地了解这种畸形。
3 例 60 多岁的男性和女性患者因脊髓血肿（2 例）或进行性脊髓病（1 例）接受了手术治疗，并通过数字减影血管造影（DSA）比较了所有 3 例的手术发现，以确定血管构筑结构。
C1 和 C2 神经根动脉以及前后脊髓动脉以各种组合和通过各种途径为单一髓内引流静脉提供供血动脉。引流静脉沿受累的腹神经根走行，并位于脊髓腹侧。分流至静脉的部位有多处：硬脑膜、蛛网膜下腔腹神经根旁和脊髓表面，表现出典型的硬脑膜 AVF 的血管结构，即一个或多个硬脑膜动脉供血的直接动静脉短路，位于脊髓根袖附近，最终流入单一引流静脉，除了由脊髓动脉供血的供应动脉引起的硬脑膜内分流。2 例出血性起病的引流血管向头侧流动，1 例伴有充血性脊髓病的引流血管向头侧和尾侧流动。由于供血动脉和多个分流部位的复杂募集，术前难以确定分流部位和供血动脉。通过仔细比较 DSA 图像和手术视频，术后明确了这些病例的血管构筑结构。直接手术干预使所有 3 例患者均获得良好的预后。
高位颈椎复杂 AVF 具有不同于其他脊髓区域的独特血管构筑特征。
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