Takai Keisuke
Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital.
Neurol Med Chir (Tokyo). 2017 Jul 15;57(7):356-365. doi: 10.2176/nmc.ra.2016-0316. Epub 2017 May 18.
The purposes of this study were to review historical changes in the classification of spinal arteriovenous (AV) shunts and to propose a practical classification system. The associated literature regarding the classification of spinal AV shunts was reviewed in the angiography era between 1967 and 2015. The classification systems of spinal AV shunts and a proposed classification system were presented with neuroradiological imaging and medical illustrations. There have been seven major classification systems based on the evolution of diagnostic methods as well as treatments for spinal AV shunts: the first description of spinal AV shunts diagnosed and classified using spinal angiography in 1971; the second classification based on a case report of intradural direct perimedullary arteriovenous fistulas (AVFs) treated by microsurgery in 1987; the third classification based on a case series of intradural perimedullary AVFs treated by endovascular interventions in 1993; the fourth and fifth classification systems based on a case series of spinal AVFs and arteriovenous malformations (AVMs) treated by microsurgery or endovascular interventions in 2002; the sixth classification based on a case series of cranio-spinal dural AV shunts in 2009; and the seventh classification based on a case series of extradural AVFs treated by microsurgery and endovascular interventions in 2011. Based on historical reports, the author proposed a classification system according to the sites (dural, intradural, and extradural) and types (AVF and AVM) of AV shunts. By learning the historical background, we may obtain a clearer understanding of the complex and confusing classification system of spinal AV shunts.
本研究的目的是回顾脊柱动静脉（AV）分流分类的历史变化，并提出一个实用的分类系统。在1967年至2015年的血管造影时代，回顾了有关脊柱AV分流分类的相关文献。通过神经放射学成像和医学插图展示了脊柱AV分流的分类系统及一个提议的分类系统。基于脊柱AV分流诊断方法及治疗方法的演变，出现了七种主要的分类系统：1971年首次描述使用脊柱血管造影诊断和分类的脊柱AV分流；1987年基于显微手术治疗硬脊膜内直接髓周动静脉瘘（AVF）的病例报告的第二种分类；1993年基于血管内介入治疗硬脊膜内髓周AVF病例系列的第三种分类；2002年基于显微手术或血管内介入治疗脊柱AVF和动静脉畸形（AVM）病例系列的第四种和第五种分类系统；2009年基于颅颈硬脑膜AV分流病例系列的第六种分类；以及2011年基于显微手术和血管内介入治疗硬膜外AVF病例系列的第七种分类。基于历史报告，作者根据AV分流的部位（硬脑膜、硬脊膜内和硬膜外）和类型（AVF和AVM）提出了一个分类系统。通过了解历史背景，我们可以更清楚地理解脊柱AV分流复杂且令人困惑的分类系统。
