Ji Tiefeng, Guo Yunbao, Shi Lei, Yu Jinlu
Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Biomed Rep. 2017 Sep;7(3):214-220. doi: 10.3892/br.2017.951. Epub 2017 Jul 25.
Spinal cord perimedullary arteriovenous fistulas (PMAVFs) are rare and belong to type IV spinal cord arteriovenous malformations (AVMs). Little is known regarding the treatment and prognosis of spinal cord PMAVFs. In the present study the relevant literature from PubMed was reviewed, and it was found that these fistulas can occur at all ages but are more common in children. In children, most spinal cord PMAVFs are large and with high flow, begin with bleeding and are frequently associated with hereditary hemorrhagic telangiectasia. However, in adults, most spinal cord PMAVFs are small and with low flow and begin with progressive spinal cord dysfunction. The early diagnosis of spinal cord PMAVFs is generally difficult, and symptoms can be very severe at the time of diagnosis. Digital subtraction angiography remains the gold standard; however, computed tomography angiography and magnetic resonance angiography are also promising. Spinal cord PMAVFs can be treated by endovascular embolization, surgical removal or a combination of the two methods. Most spinal cord PMAVFs show good outcomes after the appropriate treatment, and the prognosis is primarily associated with the blood flow of the PMAVF. For high-flow spinal cord PMAVFs, endovascular embolization is more effective and can lead to a good outcome; however, for low-flow spinal cord PMAVFs, surgical removal or the combination with endovascular embolization is the optimal choice. The prognosis for low-flow types is slightly worse than for high-flow spinal cord PMAVFs in children, but the outcome is acceptable.
脊髓髓周动静脉瘘（PMAVF）较为罕见，属于IV型脊髓动静脉畸形（AVM）。关于脊髓PMAVF的治疗和预后，人们了解甚少。在本研究中，对来自PubMed的相关文献进行了综述，发现这些瘘可发生于所有年龄段，但在儿童中更为常见。在儿童中，大多数脊髓PMAVF较大且血流高，以出血起病，常与遗传性出血性毛细血管扩张症相关。然而，在成人中，大多数脊髓PMAVF较小且血流低，以进行性脊髓功能障碍起病。脊髓PMAVF的早期诊断通常较为困难，确诊时症状可能非常严重。数字减影血管造影仍是金标准；然而，计算机断层血管造影和磁共振血管造影也很有前景。脊髓PMAVF可通过血管内栓塞、手术切除或两种方法联合治疗。大多数脊髓PMAVF经适当治疗后显示出良好的效果，预后主要与PMAVF的血流有关。对于高流量脊髓PMAVF，血管内栓塞更有效，可带来良好的结果；然而，对于低流量脊髓PMAVF，手术切除或与血管内栓塞联合是最佳选择。儿童低流量型的预后略逊于高流量脊髓PMAVF，但结果是可以接受的。
