Brinjikji Waleed, Lanzino Giuseppe
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
Handb Clin Neurol. 2017;143:161-174. doi: 10.1016/B978-0-444-63640-9.00016-3.
Spinal arteriovenous malformations (AVMs) are a rare but treatable cause of myelopathy and spinal cord hemorrhage. The clinical presentation and ideal treatment of these lesions vary widely, primarily due to differences in anatomic and angioarchitectural features. Six well-defined types of fistula have been defined: (1) intradural dorsal AVM; (2) intramedullary AVM; (3) extradural-intradural AVM; (4) intradural ventral AVF; (5) extradural/epidural AVF; and (6) conus medullaris AVM. Each of these lesions have unique clinical presentations and variable natural histories and endovascular treatment options. The principles of endovascular treatment include: (1) a complete understanding of the angioarchitecture and anatomic features of the lesion, including identification of radiculomedullary arteries; (2) careful spinal angiography; (3) identification of treatment goals prior to the procedure (i.e., complete occlusion versus partial occlusion aimed at altering natural history); (4) selection of proper embolic agent; and (5) careful follow-up in both the immediate postoperative setting and long term.
脊髓动静脉畸形（AVM）是一种罕见但可治疗的脊髓病和脊髓出血病因。这些病变的临床表现和理想治疗方法差异很大，主要是由于解剖学和血管构筑特征的不同。已定义了六种明确的瘘管类型：（1）硬脊膜内背侧AVM；（2）髓内AVM；（3）硬膜外-硬脊膜内AVM；（4）硬脊膜内腹侧动静脉瘘（AVF）；（5）硬膜外/硬脊膜外AVF；以及（6）圆锥AVM。这些病变中的每一种都有独特的临床表现、可变的自然病史和血管内治疗选择。血管内治疗的原则包括：（1）全面了解病变的血管构筑和解剖特征，包括识别神经根脊髓动脉；（2）仔细进行脊髓血管造影；（3）在手术前确定治疗目标（即完全闭塞与旨在改变自然病史的部分闭塞）；（4）选择合适的栓塞剂；以及（5）在术后即刻和长期进行仔细的随访。
