Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Service de Neuroradiologie Diagnostique et Th..rapeutique, H..pital Foch, Suresnes France.
Service de Neuroradiologie Diagnostique et Th..rapeutique, H..pital Foch, Suresnes France.
J Neuroradiol. 2022 Nov;49(6):401-408. doi: 10.1016/j.neurad.2020.09.006. Epub 2020 Sep 30.
Intradural spinal cord arteriovenous shunts (IDSCAVS) are rare and constitute a challenging situation if symptoms occur during pregnancy. We present a series of ten such cases referred to our center: five cervical, four thoracic and one lumbar.
We retrospectively reviewed our global series of 215 IDSCAVSs between 2002 and March 2020 and found ten patients who had presented during pregnancy. Clinical, radiological and therapeutic data were studied.
Seven shunts were AVM type niduses and three were micro AV-fistulae. All were associated with pial venous reflux and six hemorrhagic cases had pseudo aneurysms. Symptoms occurred mainly during the third trimester, 80% of patients presented with hemorrhage and spinal cord dysfunction. We embolized seven patients and proposed surgery in one, always after delivery: all recovered well. One woman declined treatment; one other was operated in emergency but did not improve. Mean follow-up was 3.9 years (0.5...19 years).
Despite this small group of patients, our initial experience of IDSCAVSs diagnosed during pregnancy indicates that embolization is an effective management strategy if performed after delivery and a recovery period. Results indicate that IDSCAVSs seem to have a low risk of early rebleedings after the ictal event and may be closely followed up until delivery. The results obtained show good clinical outcome without long-term rebleeds. Women with known IDSCAVSs should not be discouraged from becoming pregnant, however it seems wise to embolize them before pregnancy in order to offer protection against risks during pregnancy.
硬脊膜内脊髓动静脉分流（IDSCAVS）较为罕见，如果在怀孕期间出现症状，则构成具有挑战性的情况。我们报告了转诊至我们中心的 10 例此类病例：5 例颈椎，4 例胸椎和 1 例腰椎。
我们回顾性分析了我们在 2002 年至 2020 年 3 月期间全球范围内的 215 例 IDSCAVS 系列，发现了 10 例在怀孕期间出现的患者。研究了临床，影像学和治疗数据。
7 个分流为 AVM 型病灶，3 个为微 AV-瘘。所有病例均与软脑膜静脉反流相关，6 例出血病例存在假性动脉瘤。症状主要发生在妊娠晚期，80％的患者出现出血和脊髓功能障碍。我们对 7 例患者进行了栓塞，并对 1 例患者提出了手术建议，均在分娩后进行：所有患者均恢复良好。一位妇女拒绝了治疗；另一位妇女紧急手术，但未得到改善。平均随访时间为 3.9 年（0.5 至 19 年）。
尽管这组患者数量较少，但我们对怀孕期间诊断出的 IDSCAVS 患者的初步经验表明，如果在分娩后和恢复期进行栓塞，则是一种有效的治疗策略。结果表明，IDSCAVS 在发作后早期再出血的风险似乎较低，并且可以在分娩前进行密切随访。所获得的结果表明，没有长期再出血的情况下，临床结局良好。对于已知患有 IDSCAVS 的女性，不应劝阻其怀孕，但是在怀孕之前对其进行栓塞似乎是明智的，以防止怀孕期间的风险。
