Kramer Christopher L
Continuum (Minneap Minn). 2018 Apr;24(2, Spinal Cord Disorders):407-426. doi: 10.1212/CON.0000000000000595.
Prompt recognition and timely management of vascular disorders of the spinal cord can improve patient outcomes. This article provides contemporary and practical knowledge about the most common vascular myelopathies.
New studies have provided additional information on the risk factors and impact of neurologic monitoring on perioperative spinal cord infarction. Additionally, recent publications have provided information on the impact of misdiagnosis, corticosteroid treatment, and postoperative prognosis in the treatment of spinal dural arteriovenous fistulas and have discussed the outcome of patients with spinal arteriovenous malformations treated with embolization, surgery, and stereotactic radiosurgery. Finally, recent studies have provided information on the natural history and postoperative prognosis of spinal cavernous malformations and on the risk factors and surgical outcome of patients with spinal epidural hematomas.
Diagnostic and therapeutic challenges are inherent in managing patients with vascular disorders of the spinal cord, and clinicians should have a thorough understanding of these disorders to facilitate optimal outcomes for patients with these potentially devastating illnesses. This article begins by reviewing functional vascular anatomy and subsequently describes the fundamental characteristics of both ischemic and hemorrhagic vascular myelopathies to equip clinicians with the knowledge to avoid common pitfalls.
及时识别并妥善处理脊髓血管疾病可改善患者预后。本文提供了有关最常见血管性脊髓病的当代实用知识。
新研究提供了关于围手术期脊髓梗死的危险因素以及神经监测影响的更多信息。此外,近期出版物提供了关于脊髓硬脊膜动静脉瘘误诊、皮质类固醇治疗及术后预后影响的信息,并讨论了经栓塞、手术和立体定向放射外科治疗的脊髓动静脉畸形患者的预后。最后,近期研究提供了关于脊髓海绵状畸形自然史和术后预后以及脊髓硬膜外血肿患者危险因素和手术结果的信息。
脊髓血管疾病患者的管理存在诊断和治疗挑战,临床医生应全面了解这些疾病,以便为患有这些潜在毁灭性疾病的患者实现最佳治疗效果。本文首先回顾功能性血管解剖结构,随后描述缺血性和出血性血管性脊髓病的基本特征,使临床医生具备避免常见失误的知识。