From the Departments of Diagnostic and Interventional Neuroradiology (F.J., O.N., M.M.).
Diagnostic and Interventional Radiology (O.N.).
AJNR Am J Neuroradiol. 2018 Feb;39(2):392-398. doi: 10.3174/ajnr.A5497. Epub 2017 Dec 28.
Spinal dural arteriovenous fistulas located in the deep lumbosacral region are rare and the most difficult to diagnose among spinal dural arteriovenous fistulas located elsewhere in the spinal dura. Specific clinical and radiologic features of these fistulas are still inadequately reported and are the subject of this study.
We retrospectively evaluated all data of patients with spinal dural arteriovenous fistulas treated and/or diagnosed in our institution between 1990 and 2017. Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this study.
The most common neurologic findings at the time of admission were paraparesis (85%), sphincter dysfunction (70%), and sensory disturbances (20%). Medullary T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 19/20 (95%) patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal dural arteriovenous fistula at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients.
Clinical symptoms caused by deep lumbosacral spinal dural arteriovenous fistulas are comparable with those of spinal dural arteriovenous fistulas at other locations. Medullary congestion in association with an enlargement of the filum vein or other lumbar radicular veins is a characteristic finding in these patients. Spinal time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to localize deep lumbosacral-located fistulas with a high sensitivity before DSA. Definite detection of these fistulas remains challenging and requires sufficient visualization of the fistula-supplying arteries and draining veins by conventional spinal angiography.
位于腰骶深部的脊髓硬脊膜动静脉瘘较为罕见，且是脊髓硬脊膜动静脉瘘中最难诊断的部位。这些瘘的具体临床和影像学特征仍报道不足，是本研究的主题。
我们回顾性评估了 1990 年至 2017 年在我院治疗和/或诊断的所有脊髓硬脊膜动静脉瘘患者的数据。本研究纳入 20 例腰骶深部脊髓硬脊膜动静脉瘘患者。
入院时最常见的神经学表现为截瘫（85%）、括约肌功能障碍（70%）和感觉障碍（20%）。大多数病例的髓内 T2 高信号和增强。20/20（95%）例患者的终丝静脉和/或腰静脉扩张。8/8（88%）例接受时间分辨对比增强动态 MRA 的患者在腰骶部水平或以下显示脊髓硬脊膜动静脉瘘，7/8（88%）例患者在 DSA 前接受时间分辨对比增强动态 MRA。5 例（25%）患者通过 DSA 检测到瘘的双侧动脉供应。
腰骶部脊髓硬脊膜动静脉瘘引起的临床症状与其他部位的脊髓硬脊膜动静脉瘘相似。脊髓充血伴终丝静脉或其他腰神经根静脉扩张是这些患者的特征性表现。脊髓时间分辨对比增强动态 MRA 有助于在 DSA 前以较高的灵敏度检测引流静脉，并有助于定位腰骶部的瘘。这些瘘的明确检测仍然具有挑战性，需要通过常规脊髓血管造影充分显示瘘的供血动脉和引流静脉。
