Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK.
Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK.
Br J Radiol. 2020 Jun;93(1110):20200020. doi: 10.1259/bjr.20200020. Epub 2020 Apr 2.
We report a novel method to provide excellent anatomical depiction of a dural arteriovenous fistula (dAVF) for surgical planning.
A 78-year-old female presented with progressive back pain, deteriorating mobility and urinary incontinence with a background of obesity and severe osteoarthritis. Initial MRI suspected dAVF and subsequent spinal angiography encountered an extremely tortuous and arteriosclerotic aorta, hence catheterisation of the segmental-intercostal and lumbar vessels proved challenging. Contrast injection into the aortic arch via a pigtail catheter for arterial-phase CT angiogram of the descending aorta was performed.
This modality of imaging delineated the dAVF showing extensive involvement of the whole spine accounting for the patient's symptoms. Furthermore this allowed characterisation of bony anatomy in relation to the fistula facilitating precise surgical approach. The dAVF was successfully disconnected through a localised laminectomy centred over the lesion.
This specific technique for dAVF characterisation has not been previously reported, although trans-venous angiography has been used to some effect. In view of diagnostic and therapeutic technical difficulties that are often faced in such patients, this technique may be a useful alternative that is not only helpful in accurate diagnosis but helps in providing an invaluable guide for the surgical approach.
This case highlights the difficulties that one may be faced within cases of tortuous vasculature and the obese patient population. With this in mind we demonstrate how a unique hybridised technique may provide valuable alternative to the neurosciences team should such a future scenario arise.
我们报告一种新方法，可提供出色的硬脑膜动静脉瘘（dAVF）解剖描述，以辅助手术规划。
一名 78 岁女性因进行性背痛、活动能力恶化和尿失禁就诊，有肥胖和严重骨关节炎病史。最初的 MRI 怀疑为 dAVF，随后的脊髓血管造影检查遇到了极度迂曲和动脉粥样硬化的主动脉，因此导管插入节段性肋间和腰椎血管具有挑战性。通过猪尾导管向主动脉弓内注入造影剂，进行降主动脉动脉期 CT 血管造影。
这种成像方式描绘了 dAVF，显示整个脊柱广泛受累，与患者的症状有关。此外，这还可以描述与瘘相关的骨骼解剖结构，从而有助于精确的手术入路。通过集中于病变的局部椎板切除术成功地使 dAVF 断开连接。
这种特定的 dAVF 特征描述技术以前没有报道过，尽管已经使用了经静脉血管造影术。鉴于此类患者经常面临诊断和治疗技术方面的困难，这种技术可能是一种有用的替代方法，不仅有助于准确诊断，而且有助于为手术入路提供宝贵的指导。
本病例强调了在迂曲血管和肥胖患者群体中可能面临的困难。有鉴于此，我们展示了在出现这种情况时，这种独特的混合技术如何为神经科学团队提供有价值的替代方案。
