Phadke Rajendra V, Bhattacharyya Avik, Handique Akash, Jain Krishan, Kumar Alok, Singh Vivek, Baruah Deb, Kumar Tushant, Patwari Sriram, Mohan B Madan
Sanjay Gandhi Postgraduate Institute of Medical Sciences; Lucknow, Uttar Pradesh, India -
Institute of Postgraduate Medical Education & Research; Kolkata, India.
Interv Neuroradiol. 2014 May-Jun;20(3):357-67. doi: 10.15274/INR-2014-10056. Epub 2013 Jun 17.
This study includes 20 patients with 21 spinal perimedullary fistulae. There were nine Type IVa (42.8%) lesions, ten Type IVb (47.6%) and two Type IVc (9.5%) lesions. The dominant arterial supply was from the anterior spinal artery (47.6%), posterior spinal artery (19%) and directly from the radiculomedullary artery (28.5%). Sixteen lesions in 15 patients were treated by endovascular route using n-butyl-2-cyanoacrylate. Endovascular treatment was not feasible in five patients. Of the ten patients with microfistulae, catheterization failed/was not attempted in 40%, complete obliteration of the lesion was seen in 60% but clinical improvement was seen in 40% of patients. Catheterization was feasible in all ten patients with macrofistulae (nine type IVb and two type IVc lesions). Complete obliteration of the lesions was seen in 60% and residue in 30%. Clinical improvement was seen in 80% and clinical deterioration in 10%. In conclusion, endovascular glue embolization is safe and efficacious in type IVb and IVc spinal perimedullary fistulae and should be considered the first option of treatment. It is also feasible in many of the type IVa lesions.
本研究纳入了20例患有21处脊髓髓周瘘的患者。其中有9处IVa型病变（42.8%）、10处IVb型病变（47.6%）和2处IVc型病变（9.5%）。主要供血动脉来自脊髓前动脉（47.6%）、脊髓后动脉（19%）以及直接来自神经根髓动脉（28.5%）。15例患者中的16处病变采用正丁基-2-氰基丙烯酸酯经血管内途径治疗。5例患者经血管内治疗不可行。在10例患有微瘘的患者中，40%的患者导管插入失败/未尝试，60%的患者病变完全闭塞，但40%的患者有临床改善。所有10例患有大瘘的患者（9处IVb型和2处IVc型病变）导管插入均可行。60%的患者病变完全闭塞，30%有残留。80%的患者有临床改善，10%的患者临床恶化。总之，血管内胶水栓塞术治疗IVb型和IVc型脊髓髓周瘘安全有效，应被视为首选治疗方法。在许多IVa型病变中该方法也可行。
