Sato Kei, Morofuji Yoichi, Sadakata Eisaku, Horie Nobutaka, Izumo Tsuyoshi, Anda Takeo, Matsuo Takayuki
Department of Neurosurgery, Nagasaki University School of Biomedical Science.
No Shinkei Geka. 2020 Mar;48(3):245-251. doi: 10.11477/mf.1436204170.
An 82-year-old man presented with lower extremity weakness, paresthesia, and gait disturbance. At the previous hospital, spinal MRI had demonstrated a high-intensity area confined to the thoracic spinal cord on T2-weighted images and prominent dorsal venous flow voids that were suggestive of a thoracolumbar dural arteriovenous fistula(dAVF). Spinal digital subtraction angiography(DSA)failed to detect the shunt point. MRDSA of the head revealed a dAVF at the craniocervical junction(CCJ). Cranial DSA demonstrated feeders from the left vertebral artery and left radicular artery, a shunting point on the dura at the CCJ, and drainers into the anterior and posterior spinal veins descending to the sacral level. Surgery improved his symptoms, and the abnormal imaging findings were resolved. Observation of a dAVF at the CCJ with myelopathy is rare, and the diagnosis of this type of dAVF might be challenging. MRDSA might be a useful tool for detecting this uncommon dAVF.
一名82岁男性出现下肢无力、感觉异常和步态障碍。在之前的医院，脊柱MRI在T2加权图像上显示局限于胸段脊髓的高强度区域以及提示胸腰段硬脊膜动静脉瘘（dAVF）的明显的背侧静脉血流空洞。脊髓数字减影血管造影（DSA）未能检测到分流点。头部磁共振血管造影（MRDSA）显示颅颈交界区（CCJ）存在dAVF。头颅DSA显示来自左椎动脉和左神经根动脉的供血支、CCJ硬脑膜上的分流点以及向下至骶段水平的前、后脊髓静脉的引流支。手术改善了他的症状，异常影像学表现也得到解决。观察到CCJ处伴有脊髓病的dAVF很罕见，诊断这类dAVF可能具有挑战性。MRDSA可能是检测这种罕见dAVF的有用工具。
